HSR&D Home » Research » IIR 01-108 – HSR&D Study
Clinical Reminders in Test Reports to Improve Guideline Compliance
Paul A. Heidenreich, MD MS
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: October 2003 - September 2006
Although beta-blockers are known to prolong survival for patients with reduced left ventricular ejection fraction, their use in the community and the VA is suboptimal.
To determine if a reminder attached to the echocardiography report would increase the use of beta-blockers among patients with depressed left ventricular function.
We are randomizing consecutive patients undergoing echocardiography at one of three VA echocardiography laboratories with reduced left ventricular ejection fraction (<40%) and no echocardiographic contraindication to beta-blockers (e.g. aortic stenosis) to a reminder for use of beta-blockers or to no reminder. The reminder gives starting doses for two commonly used beta-blockers (carvedilol and metoprolol). Patients are excluded from the analysis if they leave the health care system or die within three months of randomization. The primary outcome is a prescription for a beta-blocker between three and nine months following echocardiography
The mean age of the 1271 included patients was 69 years, 60% had a history of heart failure, and 51% were receiving treatment with beta-blockers at the time of echocardiography. More patients randomized to the reminder had a subsequent beta-blocker prescription (74%, 458/621), compared to those randomized to no reminder (66%, 428/650, p=0.002). Reminders were most effective for patients without a prior history of heart failure (beta-blocker use 75% reminder vs. 61% no reminder, p=0.001), and without prior use of beta-blockers (subsequent beta-blocker use: 56% reminder vs. 44% no reminder, p=0.003).
The reminder for the beta-blocker has been implemented in the Palo Alto Health Care System. The CHF QUERI has chosen to promote this reminder and will be evaluting different methods of its implementation in a randomized trial to begin in fiscal year 2008.
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DRA: Health Systems
DRE: Diagnosis, Treatment - Observational, Prevention
Keywords: Behavior (provider), Cardiovasc’r disease, Clinical practice guidelines
MeSH Terms: none