Two important reasons for suboptimal patient and provider compliance with health maintenance recommendations are lack of involvement of inactive patients in health maintenance programs and the need for better organizational structures to facilitate health maintenance by providers. This study is a prospective, randomized, controlled trial comparing a computerized tracking system for health maintenance with a manual flowsheet based system. Adult members of 1000 families randomly selected from four rural offices of Tri-County Family Medicine will be divided into a Trial group (T) receiving computerized health maintenance tracking and a Control group (C) having health maintenance done by a manual flowsheet method. An initial chart audit with phone confirmation will define the demographic characteristics of the active and inactive members of study families and their baseline health maintenance compliance. During the two year intervention phase of the three year project computerized health maintenance status reports and reminders will be generated annually for group T patients regardless of activity status. The provider will use the manual flowsheet to track health maintenance for group C patients and must initiate patient reminders. Inactive patients contacted by phone who are receiving care elsewhere or refuse health maintenance will be surveyed to determine current health maintenance practices. A final chart audit will allow comparison of health maintenance compliance between groups T and C, of provider compliance with flowsheet vs computer data recording, and determination of the proportion of inactive patients becoming active as a result of computerized reminders. Statistical methods for analyzing proportions will be the primary statistical tool. Costs of the computerized system will be assessed. The study answers several important questions: 1) Who are the inactive patients in a fee-for-service practice? 2) Will they respond to health maintenance reminders? 3) Will a computerized tracking system be better accepted and utilized by providers? 4) What is the incremental cost of a computerized versus manual system?
