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Can Computer-Generated Evidence-Based Care Suggestions Enhance Evidence-Based Management of Asthma and Chronic Obstructive Pulmonary Disease? A Randomized, Controlled Trial

Authors

  • William M. Tierney,

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    • Address correspondence to William M. Tierney, M.D., Department of Medicine, Indiana University School of Medicine, M200-OPW, Wishard Memorial Hospital, 1001 West 10th St., Indianapolis, IN 46202. William M. Tierney, M.D., J. Marc Overhage, M.D., Ph.D., Michael D. Murray, PharmD., M.P.H., Lisa E. Harris, M.D., Xiao-Hua Zhou, Ph.D., Faye E. Smith, M.A., Nancy Nienaber, M.A., Clement J. McDonald, M.D., and Fredric D. Wolinsky, Ph.D., are with the Regenstrief Institute, Incorporated, Indianapolis, IN. William M. Tierney, M.D., J. Marc Overhage, M.D., Ph.D., Lisa E. Harris, M.D., Xiao-Hua Zhou, Ph.D., George J. Eckert, M.A.S., Clement J. McDonald, M.D., and Fredric D. Wolinsky, Ph.D., are with the Department of Medicine, Indiana University School of Medicine, Indianapolis, IN. William M. Tierney, M.D., is with the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN. Michael D. Murray, PharmD., M.P.H., is with the Purdue University School of Pharmacy, Indianapolis, IN. Fredric D. Wolinsky, Ph.D., is with the University of Iowa School of Medicine, Iowa City, IA.

  • J. Marc Overhage,

  • Michael D. Murray,

  • Lisa E. Harris,

  • Xiao-Hua Zhou,

  • George J. Eckert,

  • Faye E. Smith,

  • Nancy Nienaber,

  • Clement J. McDonald,

  • Fredric D. Wolinsky


Abstract

Objective. Translation of evidence-based guidelines into clinical practice has been inconsistent. We performed a randomized, controlled trial of guideline-based care suggestions delivered to physicians when writing orders on computer workstations.

Study Setting. Inner-city academic general internal medicine practice.

Study Design. Randomized, controlled trial of 246 physicians (25 percent faculty general internists, 75 percent internal medicine residents) and 20 outpatient pharmacists. We enrolled 706 of their primary care patients with asthma or chronic obstructive pulmonary disease. Care suggestions concerning drugs and monitoring were delivered to a random half of the physicians and pharmacists when writing orders or filling prescriptions using computer workstations. A 2 × 2 factorial randomization of practice sessions and pharmacists resulted in four groups of patients: physician intervention, pharmacist intervention, both interventions, and controls.

Data Extraction/Collection Methods. Adherence to the guidelines and clinical activity was assessed using patients' electronic medical records. Health-related quality of life, medication adherence, and satisfaction with care were assessed using telephone questionnaires.

Principal Findings. During their year in the study, patients made an average of five scheduled primary care visits. There were no differences between groups in adherence to the care suggestions, generic or condition-specific quality of life, satisfaction with physicians or pharmacists, medication compliance, emergency department visits, or hospitalizations. Physicians receiving the intervention had significantly higher total health care costs. Physician attitudes toward guidelines were mixed.

Conclusions. Care suggestions shown to physicians and pharmacists on computer workstations had no effect on the delivery or outcomes of care for patients with reactive airways disease.

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