Purpose: Automated reminders to clinicians at the point of care improve delivery of evidence-based preventive and disease management services. "Reminder fatigue", a declining response rate to reminders over time or with increasing numbers of reminders, can limit the effectiveness of reminder systems. We hypothesized that reminder fatigue could be prevented by 1) applying sound human factors engineering and cognitive science principles in designing the reminder system and 2) implementing the reminders with rigorous attention to organizational science principles.
Method: We conducted a logistic regression modeling the odds ratio of clinician action in response to a reminder according to the number of reminders issued at the encounter, the number of problems on the patient's problem list, patient age, and time (as number of months since launch), clustered by encounter. All encounters in a set of five academically-affiliated family medicine practices from 1 Jan 2006 through 30 Apr 2009 were included.
Result: 260,486 reminders were issued at 155,742 encounters during the sampling frame. Three or more reminders were issued at 25,325 of these encounters. Action was taken in response to 52.9% of reminders and discussion or consideration was documented in another 31.8%. The odds ratios for action in response to reminders over time, by number of prompts at encounter, and by number of problems were 1.02, 1.08, and 1.15 respectively. Age had no effect. These odds ratios are highly statistically significant because of the large sample but are minimally different from 1.
Conclusion: Clinical reminder response rates can be sustained at high levels. Key design features included issuing reminders only when a service was due, allowing clinicians to attend to reminders when doing so fit their workflow (vs. forcing attention at a specific time), keeping reminders very short and simple (action item only, no explicative material), and a team meeting and buy-in process before each new reminder was implemented.
Candidate for the Lee B. Lusted Student Prize Competition