Evaluating the effect of a web-based quality improvement system with feedback and outreach visits on guideline concordance in the field of cardiac rehabilitation: rationale and study protocolReport as inadecuate

Evaluating the effect of a web-based quality improvement system with feedback and outreach visits on guideline concordance in the field of cardiac rehabilitation: rationale and study protocol - Download this document for free, or read online. Document in PDF available to download.

Implementation Science

, 9:780

First Online: 31 December 2014Received: 19 June 2014Accepted: 19 September 2014DOI: 10.1186-s13012-014-0131-y

Cite this article as: van Engen-Verheul, M.M., de Keizer, N.F., van der Veer, S.N. et al. Implementation Sci 2014 9: 780. doi:10.1186-s13012-014-0131-y


BackgroundImplementation of clinical practice guidelines into daily care is hampered by a variety of barriers related to professional knowledge and collaboration in teams and organizations. To improve guideline concordance by changing the clinical decision-making behavior of professionals, computerized decision support CDS has been shown to be one of the most effective instruments. However, to address barriers at the organizational level, additional interventions are needed. Continuous monitoring and systematic improvement of quality are increasingly used to achieve change at this level in complex health care systems. The study aims to assess the effectiveness of a web-based quality improvement QI system with indicator-based performance feedback and educational outreach visits to overcome organizational barriers for guideline concordance in multidisciplinary teams in the field of cardiac rehabilitation CR.

MethodsA multicenter cluster-randomized trial with a balanced incomplete block design will be conducted in 18 Dutch CR clinics using an electronic patient record with CDS at the point of care. The intervention consists of i periodic performance feedback on quality indicators for CR and ii educational outreach visits to support local multidisciplinary QI teams focussing on systematically improving the care they provide. The intervention is supported by a web-based system which provides an overview of the feedback and facilitates development and monitoring of local QI plans. The primary outcome will be concordance to national CR guidelines with respect to the CR needs assessment and therapy indication procedure. Secondary outcomes are changes in performance of CR clinics as measured by structure, process and outcome indicators, and changes in practice variation on these indicators. We will also conduct a qualitative process evaluation concept-mapping methodology to assess experiences from participating CR clinics and to gain insight into factors which influence the implementation of the intervention.

DiscussionTo our knowledge, this will be the first study to evaluate the effect of providing performance feedback with a web-based system that incorporates underlying QI concepts. The results may contribute to improving CR in the Netherlands, increasing knowledge on facilitators of guideline implementation in multidisciplinary health care teams and identifying success factors of multifaceted feedback interventions.

Trial registrationNTR3251.

KeywordsQuality improvement Quality indicators Health care Cardiac rehabilitation Guideline adherence Electronic supplementary materialThe online version of this article doi:10.1186-s13012-014-0131-y contains supplementary material, which is available to authorized users.

Download fulltext PDF

Author: Mariëtte M van Engen-Verheul - Nicolette F de Keizer - Sabine N van der Veer - Hareld MC Kemps - Wilma JM Scholte op 

Source: https://link.springer.com/

Related documents