Rubenstein LV et al. 1995 "Improving patient quality-of-life with feedback to physicians about functional status."
Reference
Rubenstein LV, McCoy JM, Cope DW, et al. Improving patient quality-of-life with feedback to physicians about functional status. J Gen Intern Med 1995;10(11):607-614.
Abstract
"OBJECTIVE: To improve functional status among primary care patients. INTERVENTION: 1) Computer-generated feedback to physicians about the patient's functional status, the patient's self-reported ''chief complaint,'' and problem-specific resource and management suggestions; and 2) two brief interactive educational sessions for physicians, DESIGN: Randomized controlled trial, SETTING: University primary care clinic, PARTICIPANTS: All 73 internal medicine houseofficers and 557 of their new primary care patients. MEASURES: 1) Change in patient functional status from enrollment until six months later, using the Functional Status Questionnaire (FSQ); 2) management plans and additional information about functional status abstracted from the medical record; and 3) physician attitude about whether internists should address functional status problems. RESULTS: Emotional well-being scores improved significantly for the patients of the experimental group physicians compared with those of the control group physicians (p < 0.03), Limitations in social activities indicated as ''due to health'' decreased among the elderly (greater than or equal to 70 years of age) individuals in the experimental group compared with the control group (p < 0.03), The experimental group physicians diagnosed more symptoms of stress or anxiety than did the control group physicians (p < 0.001) and took more actions recommended by the feedback form (p < 0.02). CONCLUSIONS: Computer-generated feedback of functional status screening results accompanied by resource and management suggestions can increase physician diagnoses of impaired emotional well-being, can influence physician management of functional status problems, and can assist physicians in improving emotional well-being and social functioning among their patients."
Objective
"To improve functional status among primary care patients" through providing computer-generated feedback to physicians.
Tools Used
Type Clinic
Primary care
Size
Large
Other Information
The study was conducted in an academic primary care clinic.
Type of Health IT
Decision support system
Type of Health IT Functions
"We provided physicians with computer-generated feedback designed to identify and suggest management for functional deficits, and evaluated the effectiveness of this intervention. Feedback, which was based on patient self-report, included physical, psychological, and social functioning, the patients 'chief complaint' (i.e., the aspect of health the patient most wished to improve), diseases or conditions likely to affect functioning, and resource and management guidelines ... The experimental group physicians [received] functional status feedback reports attached to the front of each new patient's medical record."
Workflow-Related Findings
"The total number of different medical and functional status problems per patient that were listed in the visit notes written after functional status feedback was significantly higher for the experimental group than for the control group." Thirty-seven percent of the experimental group and 25 percent of the control group were described in their chart as having functional problems, especially depression or anxiety (30 percent experimental vs. 21 percent control).
"The number of interventions or specific plans for functional status problems per patient was higher for the experimental patients than for the control patients...the proportion of the plans that were recommended in our materials; i.e., emphasized in the resource manual and/or functional status feedback form, compared with plans that were not recommended, was significantly larger for the experimental patients than for the control patients."
"Feedback changed provider problem recognition most in the areas of mental and social function,...rather than in the area of physical function."
"We suspect that our positive results were due in part to the addition of resource and management guidelines to our functional status summaries and physician education."
Study Design
Randomized controlled trial (RCT)
Study Participants
"All 73 internal medicine houseofficers and 557 of their new primary care patients" participated.