Monitoring and improving guideline adherence by an electronic decision support system.

Cardiac rehabilitation is a multidisciplinary therapy for cardiac patients that is provided after cardiac events and cardiac interventions. It is optimally effective in a patient-oriented approach where each rehabilitation programme is tailored to the patient's specific needs; this approach is therefore advocated by the Dutch Guidelines Cardiac Rehabilitation.

To support professionals in applying the guidelines in daily practice, an electronic decision support system (DSS) has been developed that is based on the guidelines.

The DSS identifies the appropriate goals and therapies of a cardiac rehabilitation programme, based on the patient's condition, history, and needs.


This study evaluates the effect of the DSS on guideline adherence by conducting a cluster randomised trial. The participating cardiac rehabilitation centres will either work with an intervention version of the DSS, having full functionality, or with a control version, which comprises patient records and information management services but provides no decision support. Both versions of the DSS record patient data, guideline-based recommendations, and rehabilitation goals and therapies that are actually pursued in each patient's programme. Duration of the trial is six months in each participating CR centre.

Care providers are more likely to adhere to clinical practice guidelines when they receive guideline-based decision support by an electronic system.

N/A

Randomisation takes place at cluster (centre) level. The participating cardiac rehabilitation centres will either work with an intervention version of the DSS, having full functionality with advice, or with a control version, which comprises patient records and information management services but provides no advice regarding clinical decisions.

The system is based on the Dutch Cardiac Rehabilitation Guidelines 2004.