Effects of 'NHGDoc' on Quality of Care (NHGDoc)

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

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 Overview

• Status: Completed
• Conditions: Heart Failure
• Intervention / Treatment: Other: NHGDoc domain Heart Failure

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.

• Study Type: Interventional
• Enrollment (Actual): 120
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Netherlands
  • Nijmegen, Netherlands, 6500 HB
    • Radboud University Nijmegen Medical Centre, IQ healthcare

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Radboud University Medical Center
• Collaborators: Netherlands: Ministry of Health, Welfare and Sports
• Investigators: Principal Investigator: Tijn Kool, PhD, IQ healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

Publications and helpful links

General Publications

• Lugtenberg M, Pasveer D, van der Weijden T, Westert GP, Kool RB. Exposure to and experiences with a computerized decision support intervention in primary care: results from a process evaluation. BMC Fam Pract. 2015 Oct 16;16:141. doi: 10.1186/s12875-015-0364-0.
• Lugtenberg M, Westert GP, Pasveer D, van der Weijden T, Kool RB. Evaluating the uptake and effects of the computerized decision support system NHGDoc on quality of primary care: protocol for a large-scale cluster randomized controlled trial. Implement Sci. 2014 Oct 17;9:145. doi: 10.1186/s13012-014-0145-5.

Study record dates

Study Major Dates

• Study Start: April 1, 2013
• Primary Completion (ACTUAL): May 1, 2017
• Study Completion (ACTUAL): September 1, 2017

Study Registration Dates

• First Submitted: November 22, 2012
• First Submitted That Met QC Criteria: January 17, 2013
• First Posted (ESTIMATE): January 23, 2013

Study Record Updates

• Last Update Posted (ACTUAL): April 12, 2018
• Last Update Submitted That Met QC Criteria: April 11, 2018
• Last Verified: October 1, 2016

More Information

Terms related to this study

• Keywords: Heart failure; Patient outcomes; Computerized Decision Support System; Effects on quality of care; Process of care
• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Heart Failure
• Other Study ID Numbers: NHGDoc 2012