title: Study protocol: Cost effectiveness of two strategies to implement the NVOG guidelines on hypertension in pregnancy: An innovative strategy including a computerised decision support system compared to a common strategy of professional audit and feedback, a randomized controlled trial.
abstract: BACKGROUND
  Hypertensive disease in pregnancy remains the leading cause of maternal mortality in the Netherlands. Seventeen percent of the clinical pregnancies are complicated by hypertension and 2% by preeclampsia. The Dutch Society of Obstetrics and Gynaecology (NVOG) has developed evidence-based guidelines on the management of hypertension in pregnancy and chronic hypertension. Previous studies showed a low adherence rate to other NVOG guidelines and a large variation in usual care in the different hospitals. An explanation is that the NVOG has no general strategy of practical implementation and evaluation of its guidelines. The development of an effective and cost effective implementation strategy to improve adherence to the guidelines on hypertension in pregnancy is needed.
  
  
  METHODS
  The objective of this study is to assess the cost effectiveness of an innovative implementation strategy of the NVOG guidelines on hypertension including a computerised decision support system (BOS) compared to a common strategy of professional audit and feedback. A cluster randomised controlled trial with an economic evaluation alongside will be performed. Both pregnant women who develop severe hypertension or pre-eclampsia and professionals involved in the care for these women will participate. The main outcome measures are a combined rate of major maternal complications and process indicators extracted from the guidelines. A total of 472 patients will be included in both groups. For analysis, descriptive as well as regression techniques will be used. A cost effectiveness and cost utility analysis will be performed according to the intention-to-treat principle and from a societal perspective. Cost effectiveness ratios will be calculated using bootstrapping techniques.
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands. s.luitjes@vumc.nl.
authors.forename: Susanne He
authors.initials: SH
authors.lastname: Luitjes
authors.forename: Maurice Gaj
authors.initials: MG
authors.lastname: Wouters
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.forename: Hubertina Cj
authors.initials: HC
authors.lastname: Scheepers
authors.forename: Veerle Mh
authors.initials: VM
authors.lastname: Coupé
authors.forename: Huub
authors.initials: H
authors.lastname: Wollersheim
authors.forename: Eric Ap
authors.initials: EA
authors.lastname: Steegers
authors.forename: Martijn P
authors.initials: MP
authors.lastname: Heringa
authors.forename: Rosella Pmg
authors.initials: RP
authors.lastname: Hermens
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
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