Effects of 'NHGDoc' on Quality of Care
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).
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver)
Primary Purpose: Treatment
|Official Title:||Effects of the Computerized Decision Support System 'NHGDoc' on Quality of Care: a Cluster Randomized Controlled Trial|
- Prescribing of ACE-inhibitors/Angiotensin II [ Time Frame: One year ] [ Designated as safety issue: No ]Percentage of patients with heart failure that is prescribed ACE-inhibitors/Angiotensin II
- Prescribing of beta blockers [ Time Frame: One year ] [ Designated as safety issue: No ]Percentage of heart failure patients that is prescribed beta blockers
- Prescribing of diuretics [ Time Frame: One year ] [ Designated as safety issue: No ]Percentage of heart failure patients that is prescribed diuretics
- Hospital admissions [ Time Frame: One year ] [ Designated as safety issue: No ]Number of hospital admissions of patients with heart failure
- All cause mortality [ Time Frame: One year ] [ Designated as safety issue: No ]Number of patients with heart failure that die within the hospital
|Study Start Date:||April 2013|
|Estimated Study Completion Date:||August 2014|
|Estimated Primary Completion Date:||April 2014 (Final data collection date for primary outcome measure)|
Experimental: Active decision support
Regular NHGDoc domains plus NHGDoc domain heart failure
Other: NHGDoc domain Heart Failure
Healthcare providers receive patient specific alerts in terms of diagnosing and treatment of patients with heart failure
No Intervention: Passive decision support
Regular NHGDoc domains
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.
|Radboud University Nijmegen Medical Centre, IQ healthcare|
|Nijmegen, Netherlands, 6500 HB|
|Principal Investigator:||Marjolein Lugtenberg, PhD||IQ healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands|
|Principal Investigator:||Tijn Kool, PhD||IQ healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands|