जनरल प्रैक्टिस जर्नल

VA Hospital Cardiac Electronic Clinical Guideline Reminder Outcomes

Abstract

Chante Karimkhani, Cynthia L Venendaal, Weston T Waxweiler, Christopher George and Robert P Dellavalle

U.S. Department of Veterans Affairs (VA) physicians receive guideline reminders to prescribe medications to patients recuperating from cardiac surgery. We examined whether these electronic clinical reminders were associated with a) medication fill rates and b) 6-month risk-adjusted survival after coronary artery bypass graft (CABG) surgery. This retrospective cohort study analyzed the national VA Pharmacy Benefits Management System and the Continuous Improvement in Cardiac Surgery Program data from 10/1/1999 to 9/30/2005. Medication fill rates for a 6 month period prior to the active use of the electronic clinical reminder were compared with fill rates for a 12 month period after electronic reminder use. We found no significant difference in fill rates between the pre- and post-reminder periods. An analysis of variance (ANOVA) model tested whether medication fill rates were affected by electronic reminders. Apparent differences in fill rates before and after implementing clinical reminders disappeared after controlling for multiple comparisons using false discovery rate; therefore data was pooled across years (antihypertensive medications (AH), p = 0.80 and lipid-lowering agent medication (LL), p = 0.30). Changes in fill rates for AH and LL were similar to each other (p = 0.37). A Cox Proportional Hazard Regression model was used to determine the predictors of survival between the 6-month time period prior to the clinical reminder versus the 6-month time period after the reminder was actively used. The clinical reminders for both AHM and LLA were not significantly associated with survival (p = 0.45, hazard ratio = 2.2, confidence intervals 0.29-16). These results do not support the use of electronic clinical reminders in this setting. Instead, these findings support questioning the utility of individual electronic record clinical reminders.