Abstract
Cardiac rehabilitation is a multidisciplinary therapy aimed at recovery and secondary prevention after hospitalization for cardiac incidents (such as myocardial infarctions) and cardiac interventions (such as heart surgery). To stimulate implementation of the national guidelines, an electronic patient record system with computerised decision support functionalities called CARDSS (cardiac rehabilitation decision support system) was developed, and made available to Dutch rehabilitation clinics. The system was quantitatively evaluated in a cluster randomised trial at 31 clinics, and qualitatively by interviewing 29 users of the system. Computerised decision support was found to improve guideline concordance by increasing professional knowledge of preferred practice, by reducing inertia to previous practice, and by reducing guideline complexity. It was not effective when organizational or procedural changes were required that users considered to be beyond their responsibilities.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Institute of Medicine: Crossing the quality chasm: a new health system for the twenty-first century. National Academy Press, Washington, DC (2001)
Cabana, M.D., Rand, C.S., Powe, N.R., et al.: Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282, 1458–1465 (1999)
Grimshaw, J.M., Thomas, R.E., MacLennan, G., et al.: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol. Assess 8(6), 1–72 (2004)
Grol, R., Grimshaw, J.: From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362, 1225–1230 (2003)
Garg, A.X., Adhikari, N.K., McDonald, H., et al.: Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 293, 1223–1238 (2005)
Shiffman, R.N., Liaw, Y., Brandt, C.A., Corb, G.J.: Computer-based guideline implementation systems: a systematic review of functionality and effectiveness. J. Am. Med. Inform. Assoc. 6, 104–114 (1999)
Ades, P.: Cardiac rehabilitation and secondary prevention of coronary heart disease. N. Engl. J. Med. 345, 892–902 (2001)
World Health Organization: Needs and Action Priorities in Cardiac Rehabilitation and Secondary Prevention in Patients with CHD. WHO, Copenhagen (1993)
Short, R.: Access to cardiac rehabilitation varies widely across Europe. BMJ 336, 1095 (2008)
Rehabilitation Committee Netherlands Society of Cardiology and Netherlands Heart Foundation. In: Guidelines for Cardiac Rehabilitation 2004, Netherlands Heart Foundation, The Hague (2004)
Goud, R., Hasman, A., Peek, N.: Development of a guideline-based decision support system with explanation facilities for outpatient therapy. Comput Methods Programs Biomed. 91(2), 145–153 (2008)
Shekelle, P.G., Woolf, S.H., Eccles, M., Grimshaw, J.: Clinical guidelines: developing guidelines. BMJ 318(7183), 593–596 (1999)
De Clercq, P.A., Blom, J.A., Korsten, H.H., Hasman, A.: Approaches for creating computer-interpretable guidelines that facilitate decision support. Artif. Intell. Med. 31(1), 1–27 (2004)
Peleg, M., Tu, S., Bury, J., Ciccarese, P., Fox, J., Greenes, R.A., et al.: Comparing computer-interpretable guideline models: a case-study approach. J. Am. Med. Inform. Assoc. 10(1), 52–68 (2003)
Goud, R., Hasman, A., Strijbis, A.M., Peek, N.: A parallel guideline development and formalization strategy to improve the quality of clinical practice guidelines. Int. J. Med. Inform. 78(8), 513–520 (2009)
De Clercq, P.A., Hasman, A., Blom, J.A., et al.: Design and implementation of a framework to support the development of clinical guidelines. Int. J. Med. Inform. 64, 285–318 (2001)
Friedman, C.P., Wyatt, J.C.: Evaluation Methods in Medical Informatics, 2nd edn. Springer, New York (2006)
Goud, R., de Keizer, N.F., ter Riet, G., Wyatt, J.C., Hasman, A., Hellemans, I.M., Peek, N.: Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation. BMJ 338, b1440 (2009)
Donner, A., Klar, N.: Design and Analysis of Cluster Randomization Trials in Health Research. Arnold, London (2000)
Zeger, S.L., Liang, K.: Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42, 121–130 (1986)
Goud, R., van Engen-Verheul, M.M., de Keizer, N.F., Bal, R., Hasman, A., Hellemans, I.M., Peek, N.: The effect of computerized decision support on barriers to guideline implementation: a qualitative study in outpatient cardiac rehabilitation. Int. J. Med. Inform. 79(6), 430–437 (2010)
Verstappen, W.H., van der Weijden, T., ter Riet, G., Grimshaw, J., Winkens, R., Grol, R.: Block design allowed for control of the Hawthorne effect in a randomized controlled trial of test ordering. J. Clin. Epidemiol. 57(11), 1119–1123 (2004)
Van Engen-Verheul, M.M., de Keizer, N.F., Hellemans, I., Kraaijenhagen, R.A., Hasman, A., Peek, N.: Design of a continuous multifaceted guideline-implementation strategy based on computerized decision support. Stud. Health Technol. Inform. 160(Pt 2), 836–840 (2010)
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Peek, N., Goud, R., de Keizer, N., van Engen-Verheul, M., Kemps, H., Hasman, A. (2011). CARDSS: Development and Evaluation of a Guideline Based Decision Support System for Cardiac Rehabilitation. In: Peleg, M., Lavrač, N., Combi, C. (eds) Artificial Intelligence in Medicine. AIME 2011. Lecture Notes in Computer Science(), vol 6747. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-22218-4_15
Download citation
DOI: https://doi.org/10.1007/978-3-642-22218-4_15
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-22217-7
Online ISBN: 978-3-642-22218-4
eBook Packages: Computer ScienceComputer Science (R0)