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Feature Article

Using the Internet to boost cardiac care

A team of researchers led by Deborah A. Levine, MD, MPH, of VA's Ann Arbor Medical Center and the University of Michigan Health System, tested whether the Internet might be a good way to educate physicians on best practices in caring for patients who had previously had heart attacks, known in medical terms as actue myocardial infarction (MI). They conducted a randomized trial involving 168 VA primary care clinics and 847 health care providers in 26 states, the Virgin Islands, and Puerto Rico. The results of their study appeared Nov. 28, 2011, in the Archives of Internal Medicine.i

The team created a website with eight educational modules and educational materials. One group of physicians received an email whenever a new module was released, along with a monthly summary of new scholarly articles about the condition; a control group received a different email that provided them with a link to another VA website that offered more general information, with clinical guidelines for a number of different medical conditions, including MI.

The study found that physicians did look at the new materials: The median number of visits to the study's web site was 3.7 times per doctor, compared to 0.8 in the control group. Surprisingly, however, doctors showed only small improvements in their treatment of MI as a result of having been exposed to this additional information


There was a statistically significant improvement in only one indicator: the percentage of patients receiving prescriptions for beta-blockers, which help reduce blood pressure.

Despite this somewhat disappointing finding, the team continues to believe that offering physicians information on line is a useful and cost-effective approach to improving care. "Our 'light-touch' educational intervention combined low-intensity and high-dissemination ability, and had low staffing and resource requirements. It can generate knowledge transfer and increase learning efficiency," said Levine. She pointed out that "small improvements in post-MI care can translate into substantial benefits, given the large number of MI survivors."

Why didn't the study clearly demonstrate the effectiveness of this method? It could be that at baseline, VA physicians across the board were already performing well in treating post-MI patients, leaving little room for improvement. In addition, VA overall was making strong efforts to enhance physician's performance at the same time the study was taking place, so physicians in the control group improved along with the intervention group physicians—good news for VA patients.

i DA Levine, EM Funkhouser, TK Houston, JK Gerald, N Johnson-Roe, JJ Allison, J Richman, C Kiefe. "Improving Care After Myocardial Infarction Using a 2-Year Internet-Delivered Intervention." Arch Intern Med. 2011;171(21):1910-1917. Doi:10.1001/archinternmed.2011.498

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