A Controlled Trial of Including Symptom Data in Computer-Based Care Suggestions for Managing Patients with Chronic Heart Failure

Usha Subramanian, Stephan D. Fihn, Morris Weinberger, Laurie Plue, Faye E. Smith, Edmunds M. Udris, Mary B. McDonell, George J. Eckert, M'Hamed Temkit, Xiao Hua Zhou, Leway Chen, William M. Tierney

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)375-384
Number of pages10
JournalThe American Journal of Medicine
Volume116
Issue number6
DOIs
StatePublished - Mar 15 2004

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Heart Failure
Physicians
Hospitalization
Outpatients
Electronic Health Records
Quality of Life
Guidelines
Control Groups
Primary Care Physicians
Left Ventricular Dysfunction
Veterans
Ambulatory Care
Primary Health Care
Patient Care
Therapeutics
Morbidity
Costs and Cost Analysis

ASJC Scopus subject areas

  • Nursing(all)

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A Controlled Trial of Including Symptom Data in Computer-Based Care Suggestions for Managing Patients with Chronic Heart Failure. / Subramanian, Usha; Fihn, Stephan D.; Weinberger, Morris; Plue, Laurie; Smith, Faye E.; Udris, Edmunds M.; McDonell, Mary B.; Eckert, George J.; Temkit, M'Hamed; Zhou, Xiao Hua; Chen, Leway; Tierney, William M.

In: The American Journal of Medicine, Vol. 116, No. 6, 15.03.2004, p. 375-384.

Research output: Contribution to journalArticle

Subramanian, U, Fihn, SD, Weinberger, M, Plue, L, Smith, FE, Udris, EM, McDonell, MB, Eckert, GJ, Temkit, MH, Zhou, XH, Chen, L & Tierney, WM 2004, 'A Controlled Trial of Including Symptom Data in Computer-Based Care Suggestions for Managing Patients with Chronic Heart Failure', The American Journal of Medicine, vol. 116, no. 6, pp. 375-384. https://doi.org/10.1016/j.amjmed.2003.11.021
Subramanian, Usha ; Fihn, Stephan D. ; Weinberger, Morris ; Plue, Laurie ; Smith, Faye E. ; Udris, Edmunds M. ; McDonell, Mary B. ; Eckert, George J. ; Temkit, M'Hamed ; Zhou, Xiao Hua ; Chen, Leway ; Tierney, William M. / A Controlled Trial of Including Symptom Data in Computer-Based Care Suggestions for Managing Patients with Chronic Heart Failure. In: The American Journal of Medicine. 2004 ; Vol. 116, No. 6. pp. 375-384.
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abstract = "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.",
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T1 - A Controlled Trial of Including Symptom Data in Computer-Based Care Suggestions for Managing Patients with Chronic Heart Failure

AU - Subramanian, Usha

AU - Fihn, Stephan D.

AU - Weinberger, Morris

AU - Plue, Laurie

AU - Smith, Faye E.

AU - Udris, Edmunds M.

AU - McDonell, Mary B.

AU - Eckert, George J.

AU - Temkit, M'Hamed

AU - Zhou, Xiao Hua

AU - Chen, Leway

AU - Tierney, William M.

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N2 - 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.

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.

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