title: Design of a continuous multifaceted guideline-implementation strategy based on computerized decision support.
abstract: Implementation of clinical practice guidelines into daily care is hindered by a variety of barriers related to professional knowledge, collaboration in teams and organizations, and practicability of the guidelines. Clinical computerized decision support (CCDS) has been shown to be one of the most effective instruments to improve compliance to practice guidelines by tackling barriers related to professional knowledge. To address other barriers, however, additional interventions are needed. In this study, a continuous multifaceted guideline implementation strategy was developed which is based on CCDS but extends beyond the professional knowledge barrier. Two additional interventions were designed and embedded with CCDS in a continuous quality improvement framework. First, to address barriers within teams and organizations guideline compliance data are periodically aggregated into feedback reports for care providers. Second, barriers related to practicability of the underlying guidelines are addressed in a guideline-maintenance cycle. A case study in the field of cardiac rehabilitation is presented to demonstrate the feasibility of the developed strategy.
authors.affiliation: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. mm.vanengen-verheul@amc.uva.nl
authors.forename: Mariëtte
authors.initials: M
authors.lastname: van Engen-Verheul
authors.forename: Nicolette
authors.initials: N
authors.lastname: de Keizer
authors.forename: Irene
authors.initials: I
authors.lastname: Hellemans
authors.forename: Roderik
authors.initials: R
authors.lastname: Kraaijenhagen
authors.forename: Arie
authors.initials: A
authors.lastname: Hasman
authors.forename: Niels
authors.initials: N
authors.lastname: Peek
mesh_terms: D003327:Coronary Disease / Q000534:rehabilitation; D020000:Decision Support Systems, Clinical; D005246:Feedback; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D012047:Rehabilitation Centers