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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In their study of computerized reminders for medical residents providing routine ambulatory care, Dr Demakis and colleagues¹ note that the initial effectiveness of the reminders declined over time. In addition to the explanations provided by the authors, this finding may have been caused by time-associated changes in the patients receiving reminders vs usual care. The initial similarities in the treatment groups at baseline may not persist over time, particularly if an effective intervention promotes a higher rate of procedures among the reminder group as compared with those receiving usual care. Furthermore, subjects who remain eligible for recommended services despite their previous visits may represent an increasingly "resistant" group of patients who are less interested or less appropriate candidates for the service. An apparent decline in effectiveness of reminders might be caused by the increasing proportion of such patients.

We and others have noted such an effect in . . . [Full Text of this Article]

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Improving Residents' Compliance With Standards of Ambulatory Care: Results From the VA Cooperative Study on Computerized Reminders
John G. Demakis, Charles Beauchamp, William L. Cull, Robbin Denwood, Seth A. Eisen, Richard Lofgren, Kristen Nichol, James Woolliscroft, William G. Henderson, and for the Department of Veterans Affairs Cooperative Study Group on Computer Reminders in Ambulatory Care
JAMA. 2000;284(11):1411-1416.
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