***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Recent re-evaluation of preventive health care has result ed in more limited and directed guidelines ; nonetheless , physician compliance has remained poor . This study assessed whether an inexpensive reminder system of preventive care checklists would improve physician implementation of periodic health measures .  Residents in internal medicine were r and omly placed into two groups : one received a copy of the appropriate checklist with each patient 's medical record ; the other did not . After one year , 200 r and omly selected records were audited to determine the proportion of recommendations implemented for each patient . Residents who received checklists performed appropriate preventive health measures at a significantly higher rate than those who did not ( 0.56 + /- 0.26 versus 0.39 + /- 0.22 , p less than 0.002 ) . The actual use of the checklist to record the results was associated with an even higher rate of compliance compared with instances in which the checklists were provided but not used and instances in which checklists were not received ( 0.70 + /- 0.21 versus 0.44 + /- 0.24 and 0.39 + /- 0.22 , respectively , p less than 0.002 ) . These data suggest that a physician 's use of simple checklists can provide an inexpensive and effective means of improving implementation of periodic health maintenance OBJECTIVE To study the effect of a computerized medical record and other practice factors on the delivery of preventive health care . DESIGN Prospect i ve , controlled trial . SETTING University general internal medicine teaching clinic . PARTICIPANTS Forty-five internal medicine residents and their 4 supervising attending physicians . INTERVENTION The study group used a computerized ambulatory medical record system that included health care maintenance reminders . The control group used a conventional paper record with a health care maintenance flow sheet . MEASUREMENTS AND MAIN RESULTS The computer reminders significantly increased health care maintenance recommendations made to patients for proctosigmoidoscopy , tetanus vaccination , influenza vaccination , and pneumococcal vaccination , but not for fecal occult blood testing , mammography , Pap smears , or serum thyroxine screening in the elderly . First-year residents were nearly twice as successful as third-year residents in overall health care maintenance . Success scores varied markedly depending on which attending physician was supervising the residents . We found a strong interaction among group assignment , supervising attending , and level of training such that the reminders doubled success scores among first-year residents supervised by two of the attending physicians but had little effect on other subgroups . The time of year and the format of the reminder also had important effects for some of the maneuvers . CONCLUSIONS Although computerized medical records markedly improved the performance of prevention maneuvers by committed physicians , many physicians using computer systems failed to make use of the re source . The reasons for this were complex . Future work in this area should carefully control for personal behaviors and focus upon administrative changes that more effectively implement these potentially powerful tools BACKGROUND Many hospitalized Medical Service patients are at risk for venous thromboembolism in the months after discharge . We conducted a multicenter r and omized controlled trial to test whether a hospital staff member 's thromboprophylaxis alert to an Attending Physician before discharge will increase the rate of extended out-of-hospital prophylaxis and , in turn , reduce the incidence of symptomatic venous thromboembolism at 90 days . METHODS From April 2009 to January 2010 , we enrolled hospitalized Medical Service patients using the point score system developed by Kucher et al to identify those at high risk for venous thromboembolism who were not ordered to receive thromboprophylaxis after discharge . There were 2513 eligible patients from 18 study sites r and omized by computer in a 1:1 ratio to the alert group or the control group . RESULTS Patients in the alert group were more than twice as likely to receive thromboprophylaxis at discharge as controls ( 22.0 % vs 9.7 % , P < .0001 ) . Based on an intention-to-treat analysis , symptomatic venous thromboembolism at 90 days ( 99.9 % follow-up ) occurred in 4.5 % of patients in the alert group , compared with 4.0 % of controls ( hazard ratio 1.12 ; 95 % confidence interval , 0.74 - 1.69 ) . The rate of major bleeding at 30 days in the alert group was similar to that of the control group ( 1.2 % vs 1.2 % , hazard ratio 0.94 ; 95 % confidence interval , 0.44 - 2.01 ) . CONCLUSIONS Alerting providers to extend thromboprophylaxis after hospital discharge in Medical Service patients increased the rate of prophylaxis but did not decrease the rate of symptomatic venous thromboembolism BACKGROUND Most elderly patients do not receive recommended preventive care , acute care , and care for chronic conditions . METHODS We conducted a controlled trial to assess the effectiveness of electronic medical record ( EMR ) reminders , with or without panel management , on health care proxy design ation , osteoporosis screening , and influenza and pneumococcal vaccinations in patients older than 65 years . Physicians were assigned to 1 of the following 3 arms : EMR reminder , EMR reminder plus panel manager , or control . We assessed completion of recommended practice s during a 1-year period . RESULTS Among patients who had not already received the recommended care , health care proxy was design ated in 6.5 % of patients in the control arm , 8.8 % of the EMR reminder arm , and 19.7 % of the EMR reminder plus panel manager arm ( P=.002 ) . Bone density screening was completed in 17.7 % of patients in the control arm , 19.7 % of the EMR reminder arm , and 30.5 % of the EMR reminder plus panel manager arm ( P=.02 ) .  Pneumococcal vaccine was given to 13.1 % of patients in the control arm , 19.5 % of the EMR reminder arm , and 25.6 % of the EMR reminder plus panel manager arm ( P=.02 ) . Influenza vaccine was given to 46.8 % of patients in the control arm , 56.5 % of the EMR reminder arm , and 59.7 % of the EMR reminder plus panel manager arm ( P=.002 ) . Results were similar when adjusted for individual physician performance in the preceding year , patient age , patient sex , years cared for by the practice , and number of visits . CONCLUSIONS Electronic medical record reminders alone facilitated improvement in vaccination rates and , when augmented by panel management , facilitated further improvement in vaccination rates and boosted the rates of health care proxy design ation and bone density screening . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01313169 BACKGROUND Complete diagnostic evaluation or CDE ( i.e. , colonoscopy or combined flexible sigmoidoscopy plus barium enema X-ray ) is often not performed for persons with an abnormal screening fecal occult blood test ( FOBT+ ) result . METHOD This study evaluated the impact of a reminder-feedback and educational outreach intervention on primary care practice CDE recommendation and performance rates . Four hundred seventy primary care physicians ( PCPs ) in 318 practice s participated in the study . Patients were mailed an FOBT kit annually as part of a screening program . Practice s were r and omly assigned to a Control Group ( N = 198 ) or an Intervention Group ( N = 120 ) . During an 18-month pre-r and omization period and a 9-month post-r and omization period , 2992 screening FOBT+ patients were identified . Intervention practice s received the screening program and the intervention . Control practice s received only the screening program . Study outcomes were baseline-adjusted CDE recommendation and performance rates . RESULTS At baseline , about two-thirds of FOBT+ patients received a CDE recommendation , and about half had a CDE performed . At endpoint , CDE recommendation and performance rates were both significantly higher for the Intervention as compared to the Control practice s ( OR = 2.28 ; 95 % CI : 1.37 , 3.78 , and OR = 1.63 ; 95 % CI : 1.06 , 2.50 , respectively ) . CONCLUSIONS The reminder-feedback plus educational outreach intervention significantly increased CDE recommendation and performance Background Recent review s have shown that while clustering is extremely common in individually r and omised trials ( for example , clustering within centre , therapist , or surgeon ) , it is rarely accounted for in the trial analysis . Our aim is to develop a general framework for assessing whether potential sources of clustering must be accounted for in the trial analysis to obtain valid type I error rates ( non-ignorable clustering ) , with a particular focus on individually r and omised trials . Methods A general framework for assessing clustering is developed based on theoretical results and a case study of a recently published trial is used to illustrate the concepts . A simulation study is used to explore the impact of not accounting for non-ignorable clustering in practice . Results Clustering is non-ignorable when there is both correlation between patient outcomes within clusters , and correlation between treatment assignments within clusters . This occurs when the intraclass correlation coefficient is non-zero , and when the cluster has been used in the r and omisation process ( e.g. stratified blocks within centre ) or when patients are assigned to clusters after r and omisation with different probabilities ( e.g. a surgery trial in which surgeons treat patients in only one arm ) . A case study of an individually r and omised trial found multiple sources of clustering , including centre of recruitment , attending surgeon , and site of rehabilitation class . Simulations show that failure to account for non-ignorable clustering in trial analyses can lead to type I error rates over 20 % in certain cases ; conversely , adjusting for the clustering in the trial analysis gave correct type I error rates . Conclusions Clustering is common in individually r and omised trials . Trialists should assess potential sources of clustering during the planning stages of a trial , and account for any sources of non-ignorable clustering in the trial analysis We developed a computer-stored medical record system containing a limited set of the total clinical data base -- primarily diagnostic studies and treatments . This system responds to its own content according to physician-authored reminder rules . To determine the effect of the reminder messages generated by 1490 rules on physician behavior , we r and omly assigned practitioners in a general medicine clinic to study or control groups . The computer found indications for six different actions per patient in 12 467 patients during a 2-year study : 61 study group residents who received computer  reminders responded to 49 % of these indications ; 54 control group residents , to only 29 % ( p less than 0.0001 ) . Preventive care ( occult blood testing , mammographic screening , weight reduction diets , influenza and pneumococcal vaccines ) was affected . The intentions of the study group to use a given action for an indication predicted their response to the indications ( p less than 0.03 , r2 = 0.33 ) . The intentions of the control residents did not OBJECTIVE To determine if automated screening and just in time delivery of testing and referral material s at the point of care promotes universal screening referral rates for maternal depression . METHODS The  Child Health Improvement through Computer Automation ( CHICA ) system is a decision support and electronic medical record system used in our pediatric clinics . All families of patients up to 15 months of age seen between October 2007 and July 2009 were r and omized to one of three groups : ( 1 ) screening questions printed on prescreener forms ( PSF ) completed by mothers in the waiting room with physician alerts for positive screens , ( 2 ) everything in ( 1 ) plus ' just in time ' ( JIT ) printed material s to aid physicians , and ( 3 ) a control group where physicians were simply reminded to screen on printed physician worksheets . RESULTS The main outcome of interest was whether physicians suspected a diagnosis of maternal depression and referred a mother for assistance . This occurred significantly more often in both the PSF ( 2.4 % ) and JIT groups ( 2.4 % ) than in the control group ( 1.2 % ) ( OR 2.06 , 95 % CI 1.08 to 3.93 ) . Compared to the control group , more mothers were noted to have depressed mood in the PSF ( OR 7.93 , 95 % CI 4.51 to 13.96 ) and JIT groups ( OR 8.10 , 95 % CI 4.61 to 14.25 ) . Similarly , compared to the control group , more mothers had signs of anhedonia in the PSF ( OR 12.58 , 95 % CI 5.03 to 31.46 ) and JIT groups ( OR 13.03 , 95 % CI 5.21 to 32.54 ) . CONCLUSIONS Clinical decision support systems like CHICA can improve the screening of maternal depression OBJECTIVE To compare the effectiveness of an evidence -based , systematic approach to hypertension care involving comanagement of patients by primary care physicians and clinical pharmacists versus usual care in reducing blood pressure in patients with uncontrolled hypertension . METHODS Patients in a staff model medical group with uncontrolled hypertension were r and omized to either a usual care ( UC ) or a physician-pharmacist comanagement ( PPCM ) group . All physicians in the study received both group and individual education and participated in the development of an evidence -based hypertension treatment algorithm . Physicians were then given the names of their patients whose medical records documented elevated blood pressures ( defined as systolic > or = 140 mm Hg and /or diastolic > or = 90 mm Hg for patients aged < 65 yrs , and systolic > or = 160 mm H 
    Output:
    
There is moderate quality evidence that computer-generated reminders delivered on paper to healthcare professionals achieve moderate improvement in process of care .
Two characteristics emerged as significant predictors of improvement : providing space on the reminder for a response from the clinician and providing an explanation of the reminder 's content or advice .
The heterogeneity of the reminder interventions included in this review also suggests that reminders can improve care in various setting s under various conditions