title: 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.
abstract: BACKGROUND
  Computerized decision support systems (CDSSs) are increasingly used to improve quality of care. There is evidence for moderate to large effects from randomized controlled trials (RCTs), but evidence on their effectiveness when implemented at a national level is lacking. In the Netherlands, the Dutch College of General Practitioners (NHG) initiated their successful guideline program already 30 years ago. NHGDoc, a CDSS based on these NHG guidelines, covering multiple disease areas for general practice, was developed in 2006 with the aim to improve quality of primary care. In this paper, a protocol is presented to evaluate the uptake and effects of NHGDoc.
  
  
  METHODS
  A cluster RCT will be conducted among 120 general practices in the Netherlands. Eligible general practices will be randomized to receive either the regular NHGDoc decision support modules (control arm) or the regular modules plus an additional module on heart failure (intervention arm). The heart failure module consists of patient-specific alerts concerning the treatment of patients with heart failure. The effect evaluation will focus on performance indicators (e.g., prescription behavior) as well as on patient outcomes (e.g., hospital admissions) relevant in the domain of heart failure. Additionally, a process evaluation will be conducted to gain insight into the barriers and facilitators that affect the uptake and impact of NHGDoc.
  
  
  CONCLUSIONS
  Results of this study will provide insight in the uptake and impact of a multiple-domain covering CDSS for primary care implemented by a national guideline organization to improve the quality of primary care. Whereas the trial focuses on a specific domain of care-heart failure-conclusions of this study will shed light on the functioning of CDSSs covering multiple disease areas for primary care, particularly as this study also explores the factors contributing to the system's uptake and effectiveness.
  
  
  BACKGROUND
  Clinical trials NCT01773057.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, Nijmegen, 6500, HB, The Netherlands. marjolein.lugtenberg@radboudumc.nl.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Lugtenberg
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, Nijmegen, 6500, HB, The Netherlands. gert.westert@radboudumc.nl.
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, Nijmegen, 6500, HB, The Netherlands. dennis.pasveer@radboudumc.nl.
authors.forename: Dennis
authors.initials: D
authors.lastname: Pasveer
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department of Family Medicine, Maastricht University, P.O. Box 616, Maastricht, 6200, MD, The Netherlands. trudy.vanderweijden@maastrichtuniversity.nl.
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, Nijmegen, 6500, HB, The Netherlands. tijn.kool@radboudumc.nl.
authors.forename: Rudolf B
authors.initials: RB
authors.lastname: Kool
mesh_terms: D016000:Cluster Analysis; D003199:Computer Systems / Q000706:statistics & numerical data*; D003625:Data Collection; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D004059:Diffusion of Innovation; D058006:General Practice / Q000592:standards*; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D015397:Program Evaluation; D011787:Quality of Health Care