title: Computer-generated reminders and quality of pediatric HIV care in a resource-limited setting.
abstract: OBJECTIVE
  To evaluate the impact of clinician-targeted computer-generated reminders on compliance with HIV care guidelines in a resource-limited setting.
  
  
  METHODS
  We conducted this randomized, controlled trial in an HIV referral clinic in Kenya caring for HIV-infected and HIV-exposed children (<14 years of age). For children randomly assigned to the intervention group, printed patient summaries containing computer-generated patient-specific reminders for overdue care recommendations were provided to the clinician at the time of the child's clinic visit. For children in the control group, clinicians received the summaries, but no computer-generated reminders. We compared differences between the intervention and control groups in completion of overdue tasks, including HIV testing, laboratory monitoring, initiating antiretroviral therapy, and making referrals.
  
  
  RESULTS
  During the 5-month study period, 1611 patients (49% female, 70% HIV-infected) were eligible to receive at least 1 computer-generated reminder (ie, had an overdue clinical task). We observed a fourfold increase in the completion of overdue clinical tasks when reminders were availed to providers over the course of the study (68% intervention vs 18% control, P < .001). Orders also occurred earlier for the intervention group (77 days, SD 2.4 days) compared with the control group (104 days, SD 1.2 days) (P < .001). Response rates to reminders varied significantly by type of reminder and between clinicians.
  
  
  CONCLUSIONS
  Clinician-targeted, computer-generated clinical reminders are associated with a significant increase in completion of overdue clinical tasks for HIV-infected and exposed children in a resource-limited setting.
authors: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46254, USA. mwere@iupui.edu
authors: Martin C
authors: MC
authors: Were
authors: Winstone M
authors: WM
authors: Nyandiko
authors: Kristin T L
authors: KT
authors: Huang
authors: James E
authors: JE
authors: Slaven
authors: Changyu
authors: C
authors: Shen
authors: William M
authors: WM
authors: Tierney
authors: Rachel C
authors: RC
authors: Vreeman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003201:Computers / Q000191:economics / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy*; D006295:Health Resources / Q000191:economics / Q000592:standards*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D005791:Patient Care / Q000191:economics / Q000592:standards; D010349:Patient Compliance; D011787:Quality of Health Care / Q000191:economics / Q000592:standards*; D017010:Reminder Systems / Q000191:economics / Q000592:standards*