Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation.
OBJECTIVE
To determine the extent to which computerised decision support can improve concordance of multidisciplinary teams with therapeutic decisions recommended by guidelines.


METHODS
Multicentre cluster randomised trial.


METHODS
Multidisciplinary cardiac rehabilitation teams in Dutch centres and their cardiac rehabilitation patients.


METHODS
Teams received an electronic patient record system with or without additional guideline based decision support.


METHODS
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.


BACKGROUND
Current Controlled Trials ISRCTN36656997.
Goud
Rick
R
Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1100 DD, Amsterdam, Netherlands.
de Keizer
Nicolette F
NF
ter Riet
Gerben
G
Wyatt
Jeremy C
JC
Hasman
Arie
A
Hellemans
Irene M
IM
Peek
Niels
N
D016000:Cluster Analysis; D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical / Q000295:instrumentation; D005081:Exercise Therapy; D005260:Female; D019983:Guideline Adherence; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012064:Relaxation Therapy; D016896:Treatment Outcome