Clinical studyA controlled trial of including symptom data in computer-based care suggestions for managing patients with chronic heart failure☆
Section snippets
Methods
This study was approved by the Institutional Review Boards of the Seattle and Indianapolis Veterans Affairs (VA) Medical Centers. Both sites contain four geographically separate general medicine practices and use the Department of Veterans Affairs' national electronic medical records 34, 35, 36. In Indianapolis, 25 board-certified general internists, 6 nurse practitioners, and 27 residents provide primary care to approximately 20,000 veterans during 66,000 annual visits (37). In Seattle, 33
Results
A total of 2160 patients were screened, of whom 1190 were ineligible because they lacked a heart failure diagnosis or objective evidence of left ventricular systolic dysfunction, or were unaware of their heart failure. Of the remaining 970 patients, 237 (24%) refused to participate and 13 (1%) were enrolled but did not complete the enrollment interview. Of the 720 enrolled (74% of those eligible), 355 were patients of intervention physicians and 365 were patients of control physicians; 44
Discussion
We found that a substantial number of veterans with heart failure were not receiving care in accordance to accepted local and national guidelines. For example, at enrollment half were not taking a beta-blocker and a third were not taking an ACE inhibitor. Although during the study some intervention and control patients received the indicated care, providing patient-specific symptom information with treatment suggestions was no more effective than suggestions generated by data only from
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The research reported here was supported by grants from the Department of Veterans Affairs Health Services Research and Development Service (CPG 97-001-B and REA 01-098) and the Department of Veterans Affairs Health Services Research and Career Development Program. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.