Preventive strategies for cardiovascular disease are well-known, but physician implementation of these strategies has been less than optimal. Several studies have shown that computerized reminders and/or feedback increase utilization of preventive strategies. Patient-specific reminders suggest actions that a physician should consider at the time of visit. Patient-specific feedback is a report generated after the visit, which summarizes the collected data. Peer comparison feedback provides physicians with a periodic report analyzing their patient-care results in comparison with physicians in their own practice. We will conduct our project at the Mount Sinai Medical Center's generated medical practice, where we currently have 3 teams (Groups A, B and C) or 40 primary care physicians (attendings and supervised housestaff; n=120 physicians) who serve our inner city population. We propose a two-year study, which involves all three groups. Group A physicians will receive two interventions: 1) Each physician will receive a personal digital assistant (PDA), which is a hand-held computer programmed with a reminder system that prompts entry of data essential to the management of blood pressure and lipids into standardized forms. 2) Each Group A physician will receive quarterly peer-comparison and patient-specific feedback. Group B physicians will collect data in the standard """"""""paper chart"""""""" format and receive one intervention, i.e. quarterly peer-comparison feedback. Group C physicians will collect data in the standard fashion, however, these physicians receive no intervention (i.e. no personal digital assistant and no quarterly feedback and reminders).
The aims of our study are: 1) To determine the combined of a physician- designed computer-based cardiovascular risk factor collection and reminder system and quarterly peer-comparison feedback to physicians on the degree of blood pressure and LDL-cholesterol control in an inner city population, and 2) To determine the effect of only quarterly peer- comparison feedback to physicians and groups on the degree of blood pressure and lipid control in an inner city population. Our hypothesis is that at the end of a two year intervention, use of personal digital assistants and a reminder/feedback system by Group A will improve blood pressure and lipid control by 10% compared to Group B. Group B, which receives only quarterly peer-comparison feedback, will have 10% improvement in blood pressure and lipid control compared to Group C, which documents visits in the usual fashion and receives no reminders nor feedback.
