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| Descriptive Information Fields | |||||
| Brief Title † | Computerized Guidelines Enhanced by Symptoms and History: Clinical Effects | ||||
| Official Title † | Computerized Guidelines Enhanced by Symptoms and History: Clinical Effects | ||||
| Brief Summary | 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 such reminders use symptom and history data. |
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| Detailed Description | Background: 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 such reminders use symptom and history data. Objectives: 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. Methods: 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. Status: Data Collection: Enrollment has been completed, with 503 patients enrolled from the Roudebush VAMC in Indianapolis and 250 from the VA Puget Sound Health Care System in Seattle. The trial continues without irregularities in both places. More than 80 percent of eligible patients were enrolled from both sites. Subjective data are being collected prior to scheduled visits on more than 95 percent of enrolled subjects. |
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| Study Phase | |||||
| Study Type † | Interventional | ||||
| Study Design † | Other, Randomized, Open Label, Active Control, Single Group Assignment, Efficacy Study | ||||
| Primary Outcome Measure † | |||||
| Secondary Outcome Measure † | |||||
| Condition † | Heart Failure | ||||
| Intervention † | Behavioral: Computer reminders | ||||
| MEDLINE PMIDs | 15006586, 11717604, 17238390 | ||||
| Links | |||||
| Recruitment Information Fields | |||||
| Recruitment Status † | Completed | ||||
| Enrollment † | 1000 | ||||
| Start Date † | |||||
| Completion Date | February 2001 | ||||
| Eligibility Criteria † | Inclusion Criteria: Left ventricular systolic dysfunction by echocardiogram or cardiac MUGA scan and the outpatient diagnosis of heart failure and the primary care physician's statement that he or she is actively treating the patient for heart failure. Exclusion Criteria: |
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| Gender | Both | ||||
| Ages | 18 Years and older | ||||
| Accepts Healthy Volunteers | No | ||||
| Contacts †† | |||||
| Location Countries † | United States | ||||
| Administrative Information Fields | |||||
| NCT ID † | NCT00013039 | ||||
| Organization ID | CPG 97-001 | ||||
| Secondary IDs †† | |||||
| Study Sponsor † | Department of Veterans Affairs | ||||
| Collaborators †† | |||||
| Investigators † |
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| Information Provided By | Department of Veterans Affairs | ||||
| Verification Date | January 2005 | ||||
| First Received Date † | March 14, 2001 | ||||
| Last Updated Date | October 31, 2008 | ||||