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Computerized Guidelines Enhanced by Symptoms and History: Clinical Effects



Computerized Guidelines Enhanced by Symptoms and History: Clinical Effects

For Condition: Heart Failure, Congestive
Status: Completed
Sponsor(s): Department of Veterans Affairs , Department of Veterans Affairs Health Services Research and Development Service
Synopsis: Physician compliance with practice guidelines is imperfect. Computer-generated reminders from electronic medical record systems have been shown to increase compliance with guidelines, but they often require symptom and history data, which limits computer facilitation. Heart failure is a serious condition for which compliance with established guidelines is suboptimal. Physicians' compliance with heart failure guidelines may improve if computer-generated reminders use symptom and history data. (1) Program standard computer-based guidelines for heart failure using data from the electronic medical record systems at the Indianapolis and Seattle VAMCs. (2) Establish a system for capturing data on symptoms and history from heart failure patients before scheduled primary care visits. (3) Incorporate these data into enhanced computer reminders. (4) Conduct a randomized, controlled trial comparing these two types of reminders' effects on physician prescribing, patient objective and subjective outcomes, and health care utilization. This controlled trial targets patients with objective evidence of left ventricular dysfunction on cardiac imaging studies and a current outpatient diagnosis of heart failure. Primary care physicians in the Indianapolis and Seattle VAMCs have been randomized to receive either standard heart failure treatment reminders or reminders enhanced by history/symptom data. Study data come from the VAMCs electronic medical record systems (i.e., clinical data, utilization, and costs) and patient interviews (heart failure symptoms and medication compliance, heart failure-specific quality of life, and patients' satisfaction with their primary care). Data analysis will be performed at the patient level using general estimating equations to account for patient and physician characteristics and clustering of patients within physicians.
Details:
Eligibility:
Study Type:
  Interventional, Educational/Counseling/Training, Randomized, Single Blind, Active Control, Parallel Assignment
Minimum Age/Maximum Age: 18 Years/
Genders: Both
Protocol Entry Criteria: Primary care physicians at Indianapolis and Seattle Medical Centers treating patients with heart failure.
Total Enrollment: 500

Location and Contact Information:

Seattle Medical Center
Seattle,  Washington,  98108
United States
 

Richard L. Roudebush VA Medical Center
Indianapolis,  Indiana,  46202-2884
United States
 


Additional Information:
Study ID Numbers:
  CPG 97-001; 
Study Start Date: August 1997
Record last reviewed: October 2000
Additional information available at: clinicaltrials.gov
Clinicaltrials.gov Reference link: NCT00013039

Other Heart Failure, Congestive Studies:
1. Honolulu Heart Program

2. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE)

3. Genetic Architecture of Heart Disease in Rural Brazil

4. Congestive Heart Failure Trends in the Elderly 1970-94

5. The Role of Angiotensin Type I Receptor in the Regulation of Human Peripheral Vascular Function

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