E-Reminders to Providers Boost HIV Care

A system of interactive computer alerts for providers improved outcomes for HIV-infected patients in a year-long study at Massachusetts General Hospital in Boston. The primary measure of success was an increase in CD4-positive T cell counts during the period. Other endpoints for the study were missed or unscheduled appointments and abnormal lab results. The study included 33 providers and 1,011 patients in the hospital's outpatient clinic.

The control group in the study, randomly assigned by researchers, comprised half of the total number of patients. For this group, healthcare providers received alerts only on the patients' electronic medical records. In contrast, alerts for the intervention group also appeared on the provider's home page; in biweekly emails; and via hyperlinks to appointment schedules, lab results, and previous alerts. An automated nightly check of hospital databases generated the alerts.

At the end of the year, there was a significant difference (P<0.040) in the count of CD4-positive T cells for the intervention group. This group also had better follow-up rates than the control group; rates of virologic failure were the same for both groups.

More than 90 percent of the participating providers favored adopting the alert system into the standard of care at the end of the trial. Massachusetts General has a strong informatics system, which could have affected the results of the study.

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