Electronic medical record reminders and panel management to improve primary care of elderly patients.

BACKGROUND: Most elderly patients do not receive recommended preventive care, acute care, and care for chronic conditions. METHODS: We conducted a controlled trial to assess the effectiveness of electronic medical record (EMR) reminders, with or without panel management, on health care proxy designation, osteoporosis screening, and influenza and pneumococcal vaccinations in patients older than 65 years. Physicians were assigned to 1 of the following 3 arms: EMR reminder, EMR reminder plus panel manager, or control. We assessed completion of recommended practices during a 1-year period. RESULTS: Among patients who had not already received the recommended care, health care proxy was designated in 6.5% of patients in the control arm, 8.8% of the EMR reminder arm, and 19.7% of the EMR reminder plus panel manager arm (P=.002). Bone density screening was completed in 17.7% of patients in the control arm, 19.7% of the EMR reminder arm, and 30.5% of the EMR reminder plus panel manager arm (P=.02). Pneumococcal vaccine was given to 13.1% of patients in the control arm, 19.5% of the EMR reminder arm, and 25.6% of the EMR reminder plus panel manager arm (P=.02). Influenza vaccine was given to 46.8% of patients in the control arm, 56.5% of the EMR reminder arm, and 59.7% of the EMR reminder plus panel manager arm (P=.002). Results were similar when adjusted for individual physician performance in the preceding year, patient age, patient sex, years cared for by the practice, and number of visits. CONCLUSIONS: Electronic medical record reminders alone facilitated improvement in vaccination rates and, when augmented by panel management, facilitated further improvement in vaccination rates and boosted the rates of health care proxy designation and bone density screening. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01313169.

Housestaff use of medical references in ambulatory care.

We surveyed medical house officers at the Beth Israel Deaconess Medical Center during their ambulatory rotations about their utilization of reference materials, assessing such factors as frequency, the mode of reference, and specific choice of resources. The collected data were significantly illustrative of the shift from paper-based resources to digital references. These findings confirm that availability should be of utmost priority when designing references for physicians in training.