PMID- 15006586
OWN - NLM
STAT- MEDLINE
DCOM- 20040401
LR  - 20181130
IS  - 0002-9343 (Print)
IS  - 0002-9343 (Linking)
VI  - 116
IP  - 6
DP  - 2004 Mar 15
TI  - A controlled trial of including symptom data in computer-based care suggestions 
      for managing patients with chronic heart failure.
PG  - 375-84
AB  - BACKGROUND: Heart failure is common and associated with considerable morbidity 
      and cost, yet physician adherence to treatment guidelines is suboptimal. We 
      conducted a randomized controlled study to determine if adding symptom 
      information to evidence-based, computer-generated care suggestions would affect 
      treatment decisions among primary care physicians caring for outpatients with 
      heart failure at two Veterans Affairs medical centers. METHODS: Physicians were 
      randomly assigned to receive either care suggestions generated with electronic 
      medical record data and symptom data obtained from questionnaires mailed to 
      patients within 2 weeks of scheduled outpatient visits (intervention group) or 
      suggestions generated with electronic medical record data alone (control group). 
      Patients had to have a diagnosis of heart failure and objective evidence of left 
      ventricular systolic dysfunction. We assessed physician adherence to heart 
      failure guidelines, as well as patients' New York Heart Association (NYHA) class, 
      quality of life, satisfaction with care, hospitalizations, and outpatient visits, 
      at 6 and 12 months after enrollment. RESULTS: Patients in the intervention (n = 
      355) and control (n = 365) groups were similar at baseline. At 12 months, there 
      were no significant differences in adherence to care suggestions between 
      physicians in the intervention and control groups (33% vs. 30%, P = 0.4). There 
      were also no significant changes in NYHA class (P = 0.1) and quality-of-life 
      measures (P >0.1), as well as no differences in the number of outpatient visits 
      between intervention and control patients (6.7 vs. 7.1 visits, P = 0.48). 
      Intervention patients were more satisfied with their physicians (P = 0.02) and 
      primary care visit (P = 0.02), but had more all-cause hospitalizations at 6 
      months (1.5 vs. 0.7 hospitalizations, P = 0.0002) and 12 months (2.3 vs. 1.7 
      hospitalizations, P = 0.05). CONCLUSION: Adding symptom information to 
      computer-generated care suggestions for patients with heart failure did not 
      affect physician treatment decisions or improve patient outcomes.
FAU - Subramanian, Usha
AU  - Subramanian U
AD  - Division of General Internal Medicine, Department of Medicine, Indiana University 
      School of Medicine, Indianapolis, Indiana, USA.
FAU - Fihn, Stephan D
AU  - Fihn SD
FAU - Weinberger, Morris
AU  - Weinberger M
FAU - Plue, Laurie
AU  - Plue L
FAU - Smith, Faye E
AU  - Smith FE
FAU - Udris, Edmunds M
AU  - Udris EM
FAU - McDonell, Mary B
AU  - McDonell MB
FAU - Eckert, George J
AU  - Eckert GJ
FAU - Temkit, M'Hamed
AU  - Temkit M
FAU - Zhou, Xiao-Hua
AU  - Zhou XH
FAU - Chen, Leway
AU  - Chen L
FAU - Tierney, William M
AU  - Tierney WM
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
SB  - IM
MH  - Aged
MH  - *Decision Support Systems, Clinical
MH  - Family Practice/*standards
MH  - Female
MH  - Guideline Adherence/*statistics & numerical data
MH  - Heart Failure/diagnosis/*therapy
MH  - Hospitalization/statistics & numerical data
MH  - Hospitals, Veterans/standards/statistics & numerical data
MH  - Humans
MH  - Indiana
MH  - Male
MH  - Medical Records Systems, Computerized
MH  - *Outpatient Clinics, Hospital/standards/statistics & numerical data
MH  - Patient Satisfaction
MH  - *Practice Guidelines as Topic
MH  - Quality of Life
MH  - Regression Analysis
MH  - Surveys and Questionnaires
MH  - *Therapy, Computer-Assisted
MH  - Treatment Outcome
MH  - Washington
EDAT- 2004/03/10 05:00
MHDA- 2004/04/02 05:00
CRDT- 2004/03/10 05:00
PHST- 2003/05/20 00:00 [received]
PHST- 2003/11/20 00:00 [revised]
PHST- 2003/11/20 00:00 [accepted]
PHST- 2004/03/10 05:00 [pubmed]
PHST- 2004/04/02 05:00 [medline]
PHST- 2004/03/10 05:00 [entrez]
AID - S0002934303008040 [pii]
AID - 10.1016/j.amjmed.2003.11.021 [doi]
PST - ppublish
SO  - Am J Med. 2004 Mar 15;116(6):375-84. doi: 10.1016/j.amjmed.2003.11.021.