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Lehtovuori et al. BMC Res Notes (2017) 10:700 https://doi.org/10.1186/s13104-017-3054-2RESEARCH NOTEA comparison of the ef f ects of electronic reminders and group bonuses on the recording of diagnoses in primary care: a longitudinal follow-up studyTuomo Lehtovuori 1 , Marko Raina 2 , Lasse Suominen 1 and Timo Kauppila 2,3* Abstract Objective: To improve the recording of diagnoses in visits to general practitioners, an observational retrospective study based on a before-after design was performed by installing an electronic reminder in the computerized patient chart system, reinforced in feedback delivered in superior-subordinate or development discussions with the general practitioners. The monthly rate of recording diagnoses was observed before and after the intervention. The ef f ect of this intervention on recording of diagnoses was compared with the ef f ects of fi nancial group bonuses on the same parameter in a neighbouring city.Results: Before intervention, the level of recording diagnoses was about 45% in the primary care units. Nine months after this intervention there was not yet any statistically signif i cant increase in recording of diagnoses but after 21 months it yielded a recording rate of 90% (P < 0.001). In three years, this percentage reached level over 95%. Group bonuses, a fi nancial incentive serving as a control intervention, increased this parameter from 50 to 80% (P < 0.001) in nine months, and in 21 months the level of recording diagnoses was 90%. The both methods increased the level of recording diagnoses at the same level. Group bonuses acted faster but were also more expensive.Keywords: Community health centers, Medical informatics, Primary care, Practice management, Quality improvement© The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.IntroductionIn primary care, the recording of diagnoses is needed to ensure suf f i cient treatment actions, planning activities and management of resources [1–3]. In primary care, fi nancial incentives to individual GPs [4] or to multidisci-plinary care teams [5] have been reported to be ef f ective in increasing the recording of diagnoses.In the primary care of Vantaa, the basic frequency of recording disease diagnoses was about 45%, which was considered insuf f i cient. A higher frequency of recorded diagnoses was required for planning activities and managing the resources. In a quite similar neighbor-ing city, Espoo, it was possible to increase the frequency of recording diagnoses from 55% of all visits to general practitioners to a level of 90% by using fi nancial group bonuses for primary care teams [5]. Vantaa had no resources for such fi nancial incentives. Since electronic reminders have also been shown to be ef f ective in modi-fying the work practices of GPs [6] the administration of Vantaa primary care installed an electronic reminder into the computerized patient chart system to improve the recording of diagnoses by the care teams in one of its regions, Hakunila-Länsimäki. Th is intervention was enhanced in feedback delivered in superior-subordinate or development discussions with the GPs.T h e aim of this study was to discover whether the elec-tronic reminders of the patient chart system, enhanced Open AccessBMC Research Notes*Correspondence: timo.kauppila@f i mnet.f i ; timo.kauppila@helsinki.f i 3 Department of General Practice and Primary Health Care, HUS, Institute of Clinical Medicine, University of Helsinki, P.O. Box 20, Tukholmankatu 8 B, 00014 Helsinki, FinlandFull list of author information is available at the end of the article