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  3. Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation
Research

Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1440 (Published 27 April 2009) Cite this as: BMJ 2009;338:b1440

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  1. Rick Goud, research fellow1,
  2. Nicolette F de Keizer, assistant professor1,
  3. Gerben ter Riet, associate professor12,
  4. Jeremy C Wyatt, professor3,
  5. Arie Hasman, professor1,
  6. Irene M Hellemans, cardiologist1,
  7. Niels Peek, assistant professor1
  1. 1Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1100 DD, Amsterdam, Netherlands
  2. 2Horten Centre, University of Zurich, Zurich, Switzerland
  3. 3Health Informatics Centre, University of Dundee, Dundee DD2 4BF
  1. Correspondence to: N Peek n.b.peek{at}amc.uva.nl
  • Accepted 18 December 2008

Abstract

Objective To determine the extent to which computerised decision support can improve concordance of multidisciplinary teams with therapeutic decisions recommended by guidelines.

Design Multicentre cluster randomised trial.

Participants Multidisciplinary cardiac rehabilitation teams in Dutch centres and their cardiac rehabilitation patients.

Interventions Teams received an electronic patient record system with or without additional guideline based decision support.

Main outcome measures Concordance with guideline recommendations assessed for two standard rehabilitation treatments—exercise and education therapy—and for two new but evidence based rehabilitation treatments—relaxation and lifestyle change therapy; generalised estimating equations were used to account for intra-cluster correlation and were adjusted for patient’s age, sex, and indication for cardiac rehabilitation and for type and volume of centre.

Results Data from 21 centres, including 2787 patients, were analysed. Computerised decision support increased concordance with guideline recommended therapeutic decisions for exercise therapy by 7.9% (control 84.7%; adjusted difference 3.5%, 95% confidence 0.1% to 5.2%), for education therapy by 25.7% (control 63.9%; adjusted difference 23.7%, 15.5% to 29.4%), and for relaxation therapy by 25.5% (control 34.1%; adjusted difference 41.6%, 25.2% to 51.3%). The concordance for lifestyle change therapy increased by 3.2% (control 54.1%; adjusted difference 7.1%, −2.9% to 18.3%). Computerised decision support reduced cases of both overtreatment and undertreatment.

Conclusions In a multidisciplinary team motivated to adopt a computerised decision support aid that assists in formulating guideline based care plans, computerised decision support can be effective in improving the team’s concordance with guidelines. Therefore, computerised decision support may also be considered to improve implementation of guidelines in such settings.

Trial registration Current Controlled Trials ISRCTN36656997.

Footnotes

  • We thank Niels Agtereek (formerly of the Department of Medical Informatics, Academic Medical Centre, University of Amsterdam; now at McKesson Nederland BV, Nieuwegein, the Netherlands) for his assistance with the enrolment and training of participants, the data collection, and the data audit.

  • Contributors: RG, NP, and JCW were involved in the study concept and design. RG was responsible for acquisition of data. RG, NP, GtR, NFdK, AH, and IMH were involved in analysis and interpretation of data. RG, NP, NFdK, and JCW drafted the article. All authors critically revised the manuscript for important intellectual content and approved the final version. RG is the guarantor.

  • Funding: This project was funded by ZonMW, the Netherlands Organisation for Health Research and Development, Health Care Efficiency Research Program 2004, subprogram Implementation, under project no. 945-14-205. The researchers were independent from the funder. ZonMW had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

  • Competing interests: The authors are academic originators of the software but have no financial or personal relationships with external people or external organisations that could inappropriately influence this work. The technology transfer office of the Academic Medical Centre in Amsterdam is searching for a professional software company to maintain and update the CARDSS software. Financial compensations for working at the Academic Medical Centre are according to the Dutch law.

  • Ethics approval: Not needed (according to the medical ethics committee of the Academic Medical Centre in Amsterdam).

  • Study sites (study coordinators): Antonius Hospital, Sneek (M Stolp, S Sprietsema); Bethesda Hospital, Hoogeveen (J Hein); Canisius-Wilhelmina Hospital, Nijmegen (H Peters, M Renema, F Bayat); Deventer Hospital, Deventer (R Reinderink); Elkerliek Hospital, Helmond; Groene Hart Hospital, Gouda (H Koers); Stichting Zorgsaam Hospital, Terneuzen (L Van Haecke ); Hospital De Tjongerschans, Heerenveen (D Lubberts); Hospital Gelderse Vallei, Ede (M Steenbergen); Hospital Lievensberg, Bergen op Zoom (N de Wijs, G in ‘t Veld); Hospital Nij Smellinghe, Drachten (G Nijholt, M van Aalsum); Isala Klinieken, Zwolle (A B Nieuwveld, E C J Schuck, Y M Schulte Nordholt); Jeroen Bosch Hospital, ‘s Hertogenbosch (M Groenendaal); Laurentius Hospital, Roermond (A Beurskens); Maasland Hospital, Sittard (N E Janssen, P Reijnen); Mesos Medical Centre, Utrecht (F A Verhoeff); Regional Hospital Queen Beatrix, Winterswijk (L van den Nouweland); Rehabilitation Centre Breda, Breda (H van Boxel); Rijnland Hospital, Leiderdorp (C Fransz); Rijnlands Rehabilitation Centre, Leiden (H J van Exel); Rivierenland Hospital, Tiel (P van Arkelen, H Junte); Röpcke-Zweers Hospital, Hardenberg; Slotervaart Hospital, Amsterdam (L Rombout, M Zurburg); Sophia Rehabilitation, Delft (J Wiegel); St Franciscus Gasthuis, Rotterdam; St Lucas Andreas Hospital, Amsterdam (J van Dam); Sionsberg Hospital, Dokkum (S Boersma, M Smid); University Medical Centre Groningen, Groningen (L J A Redelaar); University Medical Centre Utrecht, Utrecht (I K Geut, J Zweers); Waterland Hospital, Purmerend (E van Koningsveld); Zaans Medical Centre, Zaandam (J Blonk).

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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