Evidence map›Paper›PMID 14687254›Full record

Trial reportJournal of general internal medicine2003

Effects of computerized guidelines for managing heart disease in primary care.

William M Tierney, 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 readClinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of general internal medicine, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 27 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 27 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

82 citing papers in PubMed, 27 syntheses or guidelines pooled it.

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  11. Referral interventions from primary to specialist care: a systematic review of international evidence.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014
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  19. Guideline
  20. Effect of point-of-care computer reminders on physician behaviour: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2010
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22 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

William M TierneyRegenstrief Institute for Health Care, Indiana University School of Medicine, Indianapolis, Indiana, USA. wtierney@iupui.edu
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

Funding

COMPUTER-BASED PROSPECTIVE DRUG UTILIZATION REVIEWR01HS007763 · AHRQ · INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS · PI TIERNEY, WILLIAM M · 1993 to 1996
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AHRQ HHS 1R01-HS07763
6 · The paper itself

Abstract

backgroundElectronic information systems have been proposed as one means to reduce medical errors of commission (doing the wrong thing) and omission (not providing indicated care).

objectiveTo assess the effects of computer-based cardiac care suggestions.

designA randomized, controlled trial targeting primary care physicians and pharmacists. SUBJECTS: A total of 706 outpatients with heart failure and/or ischemic heart disease.

interventionsEvidence-based cardiac care suggestions, approved by a panel of local cardiologists and general internists, were displayed to physicians and pharmacists as they cared for enrolled patients. MEASUREMENTS: Adherence with the care suggestions, generic and condition-specific quality of life, acute exacerbations of their cardiac disease, medication compliance, health care costs, satisfaction with care, and physicians' attitudes toward guidelines.

resultsSubjects were followed for 1 year during which they made 3,419 primary care visits and were eligible for 2,609 separate cardiac care suggestions. The intervention had no effect on physicians' adherence to the care suggestions (23% for intervention patients vs 22% for controls). There were no intervention-control differences in quality of life, medication compliance, health care utilization, costs, or satisfaction with care. Physicians viewed guidelines as providing helpful information but constraining their practice and not helpful in making decisions for individual patients.

conclusionsCare suggestions generated by a sophisticated electronic medical record system failed to improve adherence to accepted practice guidelines or outcomes for patients with heart disease. Future studies must weigh the benefits and costs of different (and perhaps more Draconian) methods of affecting clinician behavior.

Indexed as

Decision Making, Computer-AssistedPractice Guidelines as TopicQuality Assurance, Health CareAlgorithmsFemaleGuideline AdherenceHeart FailureHospital Information SystemsHumansLogistic ModelsMaleMedical Records Systems, ComputerizedMicrocomputersMiddle AgedMyocardial IschemiaOutcome Assessment, Health Care

Identifiers

PMID14687254
PMCPMC1494965

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.