Evaluating the uptake and effects of the computerized decision support system NHGDoc on quality of primary care: A large scale clustered randomized controlled tria

M. Lugtenberg, G.P. Westert, D. Pasveer, T. van der Weijden, R.B. Kool

Research output: Contribution to journalArticleScientificpeer-review

57 Downloads (Pure)

Abstract

Background
Computerized decision support systems (CDSSs) are increasingly used to improve quality of care. There is evidence for moderate to large effects from randomized controlled trials (RCTs), but evidence on their effectiveness when implemented at a national level is lacking. In the Netherlands, the Dutch College of General Practitioners (NHG) initiated their successful guideline program already 30 years ago. NHGDoc, a CDSS based on these NHG guidelines, covering multiple disease areas for general practice, was developed in 2006 with the aim to improve quality of primary care. In this paper, a protocol is presented to evaluate the uptake and effects of NHGDoc.
Methods
A cluster RCT will be conducted among 120 general practices in the Netherlands. Eligible general practices will be randomized to receive either the regular NHGDoc decision support modules (control arm) or the regular modules plus an additional module on heart failure (intervention arm). The heart failure module consists of patient-specific alerts concerning the treatment of patients with heart failure. The effect evaluation will focus on performance indicators (e.g., prescription behavior) as well as on patient outcomes (e.g., hospital admissions) relevant in the domain of heart failure. Additionally, a process evaluation will be conducted to gain insight into the barriers and facilitators that affect the uptake and impact of NHGDoc.
Discussion
Results of this study will provide insight in the uptake and impact of a multiple-domain covering CDSS for primary care implemented by a national guideline organization to improve the quality of primary care. Whereas the trial focuses on a specific domain of care-heart failure-conclusions of this study will shed light on the functioning of CDSSs covering multiple disease areas for primary care, particularly as this study also explores the factors contributing to the system's uptake and effectiveness.
Keywords: Clinical decision support, Clinical practice guidelines, Primary care, Process of care, Patient outcomes
Original languageEnglish
Article number145
JournalImplementation Science
Volume9
Issue number1
DOIs
Publication statusPublished - 2014

Fingerprint

Dourine
General Practice
Netherlands
Clinical Decision Support Systems
Practice Guidelines
General Practitioners

Cite this

@article{d5c15893e19a4feea38be50831a90999,
title = "Evaluating the uptake and effects of the computerized decision support system NHGDoc on quality of primary care: A large scale clustered randomized controlled tria",
abstract = "BackgroundComputerized decision support systems (CDSSs) are increasingly used to improve quality of care. There is evidence for moderate to large effects from randomized controlled trials (RCTs), but evidence on their effectiveness when implemented at a national level is lacking. In the Netherlands, the Dutch College of General Practitioners (NHG) initiated their successful guideline program already 30 years ago. NHGDoc, a CDSS based on these NHG guidelines, covering multiple disease areas for general practice, was developed in 2006 with the aim to improve quality of primary care. In this paper, a protocol is presented to evaluate the uptake and effects of NHGDoc.MethodsA cluster RCT will be conducted among 120 general practices in the Netherlands. Eligible general practices will be randomized to receive either the regular NHGDoc decision support modules (control arm) or the regular modules plus an additional module on heart failure (intervention arm). The heart failure module consists of patient-specific alerts concerning the treatment of patients with heart failure. The effect evaluation will focus on performance indicators (e.g., prescription behavior) as well as on patient outcomes (e.g., hospital admissions) relevant in the domain of heart failure. Additionally, a process evaluation will be conducted to gain insight into the barriers and facilitators that affect the uptake and impact of NHGDoc.DiscussionResults of this study will provide insight in the uptake and impact of a multiple-domain covering CDSS for primary care implemented by a national guideline organization to improve the quality of primary care. Whereas the trial focuses on a specific domain of care-heart failure-conclusions of this study will shed light on the functioning of CDSSs covering multiple disease areas for primary care, particularly as this study also explores the factors contributing to the system's uptake and effectiveness.Keywords: Clinical decision support, Clinical practice guidelines, Primary care, Process of care, Patient outcomes",
author = "M. Lugtenberg and G.P. Westert and D. Pasveer and {van der Weijden}, T. and R.B. Kool",
year = "2014",
doi = "10.1186/s13012-014-0145-5",
language = "English",
volume = "9",
journal = "Implementation Science",
issn = "1748-5908",
publisher = "BioMed Central",
number = "1",

}

Evaluating the uptake and effects of the computerized decision support system NHGDoc on quality of primary care : A large scale clustered randomized controlled tria. / Lugtenberg, M.; Westert, G.P.; Pasveer, D.; van der Weijden, T.; Kool, R.B.

In: Implementation Science, Vol. 9, No. 1, 145, 2014.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Evaluating the uptake and effects of the computerized decision support system NHGDoc on quality of primary care

T2 - A large scale clustered randomized controlled tria

AU - Lugtenberg, M.

AU - Westert, G.P.

AU - Pasveer, D.

AU - van der Weijden, T.

AU - Kool, R.B.

PY - 2014

Y1 - 2014

N2 - BackgroundComputerized decision support systems (CDSSs) are increasingly used to improve quality of care. There is evidence for moderate to large effects from randomized controlled trials (RCTs), but evidence on their effectiveness when implemented at a national level is lacking. In the Netherlands, the Dutch College of General Practitioners (NHG) initiated their successful guideline program already 30 years ago. NHGDoc, a CDSS based on these NHG guidelines, covering multiple disease areas for general practice, was developed in 2006 with the aim to improve quality of primary care. In this paper, a protocol is presented to evaluate the uptake and effects of NHGDoc.MethodsA cluster RCT will be conducted among 120 general practices in the Netherlands. Eligible general practices will be randomized to receive either the regular NHGDoc decision support modules (control arm) or the regular modules plus an additional module on heart failure (intervention arm). The heart failure module consists of patient-specific alerts concerning the treatment of patients with heart failure. The effect evaluation will focus on performance indicators (e.g., prescription behavior) as well as on patient outcomes (e.g., hospital admissions) relevant in the domain of heart failure. Additionally, a process evaluation will be conducted to gain insight into the barriers and facilitators that affect the uptake and impact of NHGDoc.DiscussionResults of this study will provide insight in the uptake and impact of a multiple-domain covering CDSS for primary care implemented by a national guideline organization to improve the quality of primary care. Whereas the trial focuses on a specific domain of care-heart failure-conclusions of this study will shed light on the functioning of CDSSs covering multiple disease areas for primary care, particularly as this study also explores the factors contributing to the system's uptake and effectiveness.Keywords: Clinical decision support, Clinical practice guidelines, Primary care, Process of care, Patient outcomes

AB - BackgroundComputerized decision support systems (CDSSs) are increasingly used to improve quality of care. There is evidence for moderate to large effects from randomized controlled trials (RCTs), but evidence on their effectiveness when implemented at a national level is lacking. In the Netherlands, the Dutch College of General Practitioners (NHG) initiated their successful guideline program already 30 years ago. NHGDoc, a CDSS based on these NHG guidelines, covering multiple disease areas for general practice, was developed in 2006 with the aim to improve quality of primary care. In this paper, a protocol is presented to evaluate the uptake and effects of NHGDoc.MethodsA cluster RCT will be conducted among 120 general practices in the Netherlands. Eligible general practices will be randomized to receive either the regular NHGDoc decision support modules (control arm) or the regular modules plus an additional module on heart failure (intervention arm). The heart failure module consists of patient-specific alerts concerning the treatment of patients with heart failure. The effect evaluation will focus on performance indicators (e.g., prescription behavior) as well as on patient outcomes (e.g., hospital admissions) relevant in the domain of heart failure. Additionally, a process evaluation will be conducted to gain insight into the barriers and facilitators that affect the uptake and impact of NHGDoc.DiscussionResults of this study will provide insight in the uptake and impact of a multiple-domain covering CDSS for primary care implemented by a national guideline organization to improve the quality of primary care. Whereas the trial focuses on a specific domain of care-heart failure-conclusions of this study will shed light on the functioning of CDSSs covering multiple disease areas for primary care, particularly as this study also explores the factors contributing to the system's uptake and effectiveness.Keywords: Clinical decision support, Clinical practice guidelines, Primary care, Process of care, Patient outcomes

U2 - 10.1186/s13012-014-0145-5

DO - 10.1186/s13012-014-0145-5

M3 - Article

VL - 9

JO - Implementation Science

JF - Implementation Science

SN - 1748-5908

IS - 1

M1 - 145

ER -