Effects of 'NHGDoc' on Quality of Care

Study Overview
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Brief Summary
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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
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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.

Official Title
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Effects of the Computerized Decision Support System 'NHGDoc' on Quality of Care: a Cluster Randomized Controlled Trial

Conditions
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Heart Failure

Intervention / Treatment
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* Other: NHGDoc domain Heart Failure


Participation Criteria
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Eligibility Criteria
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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
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Active decision support<br>Regular NHGDoc domains plus NHGDoc domain heart failure | Other: NHGDoc domain Heart Failure<br>* Healthcare providers receive patient specific alerts in terms of diagnosing and treatment of patients with heart failure<br>|
| No Intervention: Passive decision support<br>Regular NHGDoc domains | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prescribing of ACE-inhibitors/Angiotensin II | Percentage of patients with heart failure that is prescribed ACE-inhibitors/Angiotensin II | One year | 
| Prescribing of beta blockers | Percentage of heart failure patients that is prescribed beta blockers | One year | 
| Prescribing of diuretics | Percentage of heart failure patients that is prescribed diuretics | One year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital admissions | Number of hospital admissions of patients with heart failure | One year | 
| All cause mortality | Number of patients with heart failure that die within the hospital | One year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Computerized Decision Support System, Heart failure, Effects on quality of care, Process of care, Patient outcomes