Lionel S. Lim, MD, MPH, FACP, FACPM
Does adding a nonphysician panel manager to electronic medical record (EMR) reminders for primary care physicians (PCPs) improve completion of 4 preventive care practices in elderly patients?
Cluster randomized controlled trial. ClinicalTrials.gov NCT01313169.
A primary care practice in an academic medical center in Boston, Massachusetts, USA.
34 PCPs caring for 2730 patients who were ≥ 65 years of age (mean age 75 y, 59% women), had a designated PCP, and completed ≥ 1 visit within 18 months before study start. A nonrandomized control group of 20 PCPs and 1930 patients at a second practice was also included, but data for this group are not reported in this abstract.
EMR reminders plus a panel manager (17 PCPs, 1394 patients) or EMR reminders only (17 PCPs, 1336 patients). For all patients eligible for each recommended practice, reminders for guideline-recommended care (designation of a health care proxy, osteoporosis screening, and influenza and pneumococcal vaccinations) were displayed in each patient's EMR at the point of care. In the reminder-plus-panel manager group, an off-site administrative assistant also identified patients due for the specified practices and, with the PCP's permission, contacted patients (two 6-mo cycles of 3 phone calls and 1 letter until contact was made or the study ended). The panel manager facilitated care by sending proxy forms to patients and scheduling bone density scans and vaccinations.
Designation of a health care proxy, completion of or order for bone density scan, and administration of influenza and pneumococcal vaccines.
97% of PCPs; 100% of patients.
The reminder-plus-panel manager group had higher completion rates of health care proxies and bone density scans than the reminder-only group (Table). Groups did not differ for completion of influenza and pneumococcal vaccinations (Table).
In elderly patients, a panel manager added to electronic medical record reminders for primary preventive care increased completion of health care proxies and bone density scans but not influenza or pneumococcal vaccinations.
‡Abbreviations defined in Glossary. RBI, NNT, and CI calculated from event rates and adjusted odds ratios in article.
§Number of patients eligible for the recommended practice at baseline.
||Adjusted for physicians' performance in the previous year and patient characteristics (age, sex, years cared for by practice, and number of visits during study period).
Lim LS. Adding a panel manager to EMR reminders improved some preventive care processes. Ann Intern Med. ;156:JC1–12. doi: 10.7326/0003-4819-156-2-201201170-02012
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Published: Ann Intern Med. 2012;156(2):JC1-12.
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