title: Revision of the Dutch clinical algorithm for assessing patient needs in cardiac rehabilitation based on identified implementation problems.
abstract: BACKGROUND
  Despite all available evidence of its effectiveness, cardiac rehabilitation and secondary prevention (CRSP) is still insufficiently implemented in current clinical practice. Based on an analysis of implementation problems, recently the Dutch clinical algorithm for the assessment of patient's CRSP needs was revised. The purpose of this paper is to describe the revision process and its results to improve CRSP guideline implementation.
  
  
  METHODS
  The National Institute for Health and Clinical Excellence (NICE) guidelines manual for conducting guideline revisions was followed. Information on the use of the algorithm in practice was collected from electronic medical records and by conducting semi-structured interviews. Next, an expert advisory group identified the problems for use in daily practice and defined the scope for the revision. A multidisciplinary guideline development group subsequently wrote the revised algorithm.
  
  
  RESULTS
  A large variation in assessed patient needs was observed between CRSP clinics. Assessment based on clinical judgement was found to be a source of practice variation and is therefore avoided in the revised algorithm. It was decided to add assessment instruments for anxiety and depression, cardiovascular risk factors, stress, attitude of partner and lifestyle parameters.
  
  
  CONCLUSIONS
  The Dutch clinical algorithm for assessing patient needs for CRSP was revised using a combination of patient data from routine practice, knowledge from academic experts and experience from field experts. The revised algorithm is a practical tool consisting of assessment instruments to improve CRSP guideline adherence in the Netherlands. This algorithm may also be useful for other Western countries to organize their CRSP needs assessment procedure.
authors.affiliation: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.m.vanengen-verheul@amc.uva.nl
authors.forename: Mariëtte M
authors.initials: MM
authors.lastname: van Engen-Verheul
authors.forename: Hareld M C
authors.initials: HM
authors.lastname: Kemps
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: de Keizer
authors.forename: Irene M
authors.initials: IM
authors.lastname: Hellemans
authors.forename: Rick
authors.initials: R
authors.lastname: Goud
authors.forename: Roderik A
authors.initials: RA
authors.lastname: Kraaijenhagen
authors.forename: Niels
authors.initials: N
authors.lastname: Peek
mesh_terms: D000368:Aged; D000465:Algorithms; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006301:Health Services Needs and Demand / Q000592:standards*; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000592:standards*; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011379:Prognosis; D011787:Quality of Health Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors