Heart Failure
Conditions
Keywords
Computerized Decision Support System, Heart failure, Effects on quality of care, Process of care, Patient outcomes
Brief summary
The purpose of this study is to determine whether the computerized decision support system 'NHGDoc' is effective in improving quality of primary care in terms of processes of care (e.g. prescribing behavior of physicians) as well as outcomes of care (e.g. hospital admissions, mortality).
Detailed description
Computerized decision support systems are regarded as useful tools to improve quality of care, but their effects are still uncertain. In the Netherlands 'NHGDoc' a computerized decision support system supported by the Dutch College of General Practitioners (NHG) is currently being implemented among more than 1.000 general practices in the Netherlands. The aim of this study is to evaluate the effects of NHGDoc on quality of care. In addition, we want to gain insight into the barriers and facilitators that affect the systems' impact. A cluster randomized controlled trial will be conducted among 120 general practices in the Netherlands. Eligible practices will be randomized to receive either the regular NHGDoc modules (control arm) or the regular modules and an additional module on heart failure (intervention arm). The effect evaluation will focus on processes of care (e.g. prescription behavior) as well as on patient outcomes (e.g. hospital admissions, mortality). Additionally, a process evaluation will be conducted, which includes a focus group study and a survey among participating healthcare providers to evaluate the perceived barriers and facilitators to using 'NHGDoc'. Results of this study will provide insight in the ability of computerized decision support systems and in particular 'NHGDoc' to improve quality of primary care. Whereas the trial focuses on a specific NHGDoc domain - heart failure - we believe our conclusions are relevant to other primary care areas as well, particularly as this study also explores the factors that contribute to the systems' effectiveness.
Interventions
OTHERNHGDoc domain Heart Failure
Healthcare providers receive patient specific alerts in terms of diagnosing and treatment of patients with heart failure
Sponsors
Netherlands: Ministry of Health, Welfare and Sports
Radboud University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* General practices should use the information system MicroHIS X or Promedico ASP * NHGDoc should be available in the general practices
Exclusion criteria
* General practices that do not meet the inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prescribing of ACE-inhibitors/Angiotensin II | One year | Percentage of patients with heart failure that is prescribed ACE-inhibitors/Angiotensin II |
| Prescribing of beta blockers | One year | Percentage of heart failure patients that is prescribed beta blockers |
| Prescribing of diuretics | One year | Percentage of heart failure patients that is prescribed diuretics |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital admissions | One year | Number of hospital admissions of patients with heart failure |
| All cause mortality | One year | Number of patients with heart failure that die within the hospital |
Countries
Netherlands
Outcome results
None listed