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Phased trial of a proven algorithm at a new primary care clinic.

J J Christensen-Szalanski, P H Diehr, R W Wood and R K Tompkins

A previous study showed that a clinical algorithm for respiratory illnesses, consisting of a checklist, a set of instructions (logic), and computer audit/feedback, could reduce costs significantly while maintaining a high quality of care. The results of this study show that the algorithm system, developed and validated at one primary care clinic, can be successfully imported to another primary care clinic. In the present study, the algorithm system significantly improved the completeness of the medical records, reduced the use of medical tests by 20 per cent-75 per cent, and reduced non-provider costs by 36 per cent per patient visit. This study also shows that all three components of the algorithm system appear to be necessary to achieve these improvements and maintain a high quality of medical care. These results suggest that a wider use of the algorithm system for minor acute medical problems is both feasible and useful in providing high-quality cost-effective care that is auditable.