Improving delivery of preventive health care with the comprehensive annotated reminder tool (CART)

J Fam Pract. 2001 Sep;50(9):767-71.


Objectives: We assessed the effect of the Comprehensive Annotated Reminder Tool (CART) on physician adherence to preventive services recommendations.

Study design: Using a randomized pretest/posttest control group design, we assigned physicians to the CART group or the control group, followed up prospectively, and evaluated for appropriate adherence to guidelines. The 3 age-specific versions of the CART annotated history and physical examination form contained up to 49 preventive services recommendations.

Population: All resident physicians in a large family practice residency program were studied over the course of 1 academic year.

Outcomes measured: We performed blinded chart reviews to assess the appropriateness of preventive services ordered by the physicians before the introduction of the CART, during its use, and after its removal. A multiple-choice test completed before and after the use of the CART forms assessed knowledge.

Results: When the CART was used, the appropriateness of physician preventive behavior increased by 21% overall. The appropriateness of history, physical examination, and laboratory interventions increased by 33%. When the CART was removed, physician behavior returned to baseline (P < or = .0025 for 16 of 20 interventions). No significant differences were observed in the control group over time. Knowledge increased over the study period for all physicians (P < or = .005) but did not differ significantly between the treatment and control groups (P = .608).

Conclusions: Use of the CART significantly improved physician performance in the appropriate delivery of preventive care.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Delivery of Health Care*
  • Family Practice / education*
  • Guideline Adherence*
  • Humans
  • Internship and Residency
  • Preventive Health Services / organization & administration*