Evaluation of computer-generated reminders to improve CD4 laboratory monitoring in sub-Saharan Africa: A prospective comparative study

Martin C. Were, Changyu Shen, William M. Tierney, Joseph Mamlin, Paul Biondich, Xiaochun Li, Sylvester Kimaiyo, Burke W. Mamlin

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective: Little evidence exists on effective interventions to integrate HIV-care guidelines into practices within developing countries. This study tested the hypothesis that clinical summaries with computer-generated reminders could improve clinicians' compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. Design: A prospective comparative study of two randomly selected outpatient adult HIV clinics in western Kenya. Printed summaries with reminders for overdue CD4 tests were made available to clinicians in the intervention clinic but not in the control clinic. Measurements: Changes in order rates for overdue CD4 tests were compared between and within the two clinics. Results: The computerized reminder system identified 717 encounters (21%) with overdue CD4 tests. Analysis by study assignment (regardless of summaries being printed or not) revealed that with computer-generated reminders, CD4 order rates were significantly higher in the intervention clinic compared to the control clinic (53% vs 38%, OR=1.80, CI 1.34 to 2.42, p<0.0001). When comparison was restricted to encounters where summaries with reminders were printed, order rates in intervention clinic were even higher (63%). The intervention clinic increased CD4 ordering from 42% before reminders to 63% with reminders (50% increase, OR=2.32, CI 1.67 to 3.22, p<0.0001), compared to control clinic with only 8% increase from prestudy baseline (CI 0.83 to 1.46, p=0.51). Limitations: Evaluation was conducted at two clinics in a single institution. Conclusions: Clinical summaries with computer-generated reminders significantly improved clinician compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. This technology can have broad applicability to improve quality of HIV care in these settings.

Original languageEnglish
Pages (from-to)150-155
Number of pages6
JournalJournal of the American Medical Informatics Association
Volume18
Issue number2
DOIs
StatePublished - Mar 2011

Fingerprint

Africa South of the Sahara
HIV
Prospective Studies
Reminder Systems
Guidelines
Quality of Health Care
Kenya
Practice Guidelines
Developing Countries
Outpatients
Technology

ASJC Scopus subject areas

  • Health Informatics

Cite this

Evaluation of computer-generated reminders to improve CD4 laboratory monitoring in sub-Saharan Africa : A prospective comparative study. / Were, Martin C.; Shen, Changyu; Tierney, William M.; Mamlin, Joseph; Biondich, Paul; Li, Xiaochun; Kimaiyo, Sylvester; Mamlin, Burke W.

In: Journal of the American Medical Informatics Association, Vol. 18, No. 2, 03.2011, p. 150-155.

Research output: Contribution to journalArticle

@article{84919618811940e98c88b3f5ceef3f48,
title = "Evaluation of computer-generated reminders to improve CD4 laboratory monitoring in sub-Saharan Africa: A prospective comparative study",
abstract = "Objective: Little evidence exists on effective interventions to integrate HIV-care guidelines into practices within developing countries. This study tested the hypothesis that clinical summaries with computer-generated reminders could improve clinicians' compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. Design: A prospective comparative study of two randomly selected outpatient adult HIV clinics in western Kenya. Printed summaries with reminders for overdue CD4 tests were made available to clinicians in the intervention clinic but not in the control clinic. Measurements: Changes in order rates for overdue CD4 tests were compared between and within the two clinics. Results: The computerized reminder system identified 717 encounters (21{\%}) with overdue CD4 tests. Analysis by study assignment (regardless of summaries being printed or not) revealed that with computer-generated reminders, CD4 order rates were significantly higher in the intervention clinic compared to the control clinic (53{\%} vs 38{\%}, OR=1.80, CI 1.34 to 2.42, p<0.0001). When comparison was restricted to encounters where summaries with reminders were printed, order rates in intervention clinic were even higher (63{\%}). The intervention clinic increased CD4 ordering from 42{\%} before reminders to 63{\%} with reminders (50{\%} increase, OR=2.32, CI 1.67 to 3.22, p<0.0001), compared to control clinic with only 8{\%} increase from prestudy baseline (CI 0.83 to 1.46, p=0.51). Limitations: Evaluation was conducted at two clinics in a single institution. Conclusions: Clinical summaries with computer-generated reminders significantly improved clinician compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. This technology can have broad applicability to improve quality of HIV care in these settings.",
author = "Were, {Martin C.} and Changyu Shen and Tierney, {William M.} and Joseph Mamlin and Paul Biondich and Xiaochun Li and Sylvester Kimaiyo and Mamlin, {Burke W.}",
year = "2011",
month = "3",
doi = "10.1136/jamia.2010.005520",
language = "English",
volume = "18",
pages = "150--155",
journal = "Journal of the American Medical Informatics Association : JAMIA",
issn = "1067-5027",
publisher = "Oxford University Press",
number = "2",

}

TY - JOUR

T1 - Evaluation of computer-generated reminders to improve CD4 laboratory monitoring in sub-Saharan Africa

T2 - A prospective comparative study

AU - Were, Martin C.

AU - Shen, Changyu

AU - Tierney, William M.

AU - Mamlin, Joseph

AU - Biondich, Paul

AU - Li, Xiaochun

AU - Kimaiyo, Sylvester

AU - Mamlin, Burke W.

PY - 2011/3

Y1 - 2011/3

N2 - Objective: Little evidence exists on effective interventions to integrate HIV-care guidelines into practices within developing countries. This study tested the hypothesis that clinical summaries with computer-generated reminders could improve clinicians' compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. Design: A prospective comparative study of two randomly selected outpatient adult HIV clinics in western Kenya. Printed summaries with reminders for overdue CD4 tests were made available to clinicians in the intervention clinic but not in the control clinic. Measurements: Changes in order rates for overdue CD4 tests were compared between and within the two clinics. Results: The computerized reminder system identified 717 encounters (21%) with overdue CD4 tests. Analysis by study assignment (regardless of summaries being printed or not) revealed that with computer-generated reminders, CD4 order rates were significantly higher in the intervention clinic compared to the control clinic (53% vs 38%, OR=1.80, CI 1.34 to 2.42, p<0.0001). When comparison was restricted to encounters where summaries with reminders were printed, order rates in intervention clinic were even higher (63%). The intervention clinic increased CD4 ordering from 42% before reminders to 63% with reminders (50% increase, OR=2.32, CI 1.67 to 3.22, p<0.0001), compared to control clinic with only 8% increase from prestudy baseline (CI 0.83 to 1.46, p=0.51). Limitations: Evaluation was conducted at two clinics in a single institution. Conclusions: Clinical summaries with computer-generated reminders significantly improved clinician compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. This technology can have broad applicability to improve quality of HIV care in these settings.

AB - Objective: Little evidence exists on effective interventions to integrate HIV-care guidelines into practices within developing countries. This study tested the hypothesis that clinical summaries with computer-generated reminders could improve clinicians' compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. Design: A prospective comparative study of two randomly selected outpatient adult HIV clinics in western Kenya. Printed summaries with reminders for overdue CD4 tests were made available to clinicians in the intervention clinic but not in the control clinic. Measurements: Changes in order rates for overdue CD4 tests were compared between and within the two clinics. Results: The computerized reminder system identified 717 encounters (21%) with overdue CD4 tests. Analysis by study assignment (regardless of summaries being printed or not) revealed that with computer-generated reminders, CD4 order rates were significantly higher in the intervention clinic compared to the control clinic (53% vs 38%, OR=1.80, CI 1.34 to 2.42, p<0.0001). When comparison was restricted to encounters where summaries with reminders were printed, order rates in intervention clinic were even higher (63%). The intervention clinic increased CD4 ordering from 42% before reminders to 63% with reminders (50% increase, OR=2.32, CI 1.67 to 3.22, p<0.0001), compared to control clinic with only 8% increase from prestudy baseline (CI 0.83 to 1.46, p=0.51). Limitations: Evaluation was conducted at two clinics in a single institution. Conclusions: Clinical summaries with computer-generated reminders significantly improved clinician compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. This technology can have broad applicability to improve quality of HIV care in these settings.

UR - http://www.scopus.com/inward/record.url?scp=79953074614&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953074614&partnerID=8YFLogxK

U2 - 10.1136/jamia.2010.005520

DO - 10.1136/jamia.2010.005520

M3 - Article

C2 - 21252053

AN - SCOPUS:79953074614

VL - 18

SP - 150

EP - 155

JO - Journal of the American Medical Informatics Association : JAMIA

JF - Journal of the American Medical Informatics Association : JAMIA

SN - 1067-5027

IS - 2

ER -