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Randomized Controlled Trial
. 2009 Apr 27:338:b1440.
doi: 10.1136/bmj.b1440.

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

Rick Goud  1 , Nicolette F de Keizer, Gerben ter Riet, Jeremy C Wyatt, Arie Hasman, Irene M Hellemans, Niels Peek
Affiliations
Randomized Controlled Trial

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

Rick Goud et al. BMJ. .

Erratum in

  • BMJ. 2009;338:b1880

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.

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Conflict of interest statement

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.

Figures

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Fig 1 Flow of centres through trial
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Fig 2 Concordance of control and intervention centres with guideline recommended treatment decisions. Each box shows median value (line inside box), quartiles (box edges), extreme values (whiskers), and outliers (horizontal lines) within category
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Fig 3 Number and percentage of patients who were correctly treated (true positives), correctly untreated (true negatives), overtreated (false positives), and undertreated (false negatives) for each cardiac rehabilitation treatment, in intervention and control centres
See this image and copyright information in PMC

References

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