The effect of computerized decision support on barriers to guideline implementation: A qualitative study in outpatient cardiac rehabilitation

International Journal of Medical Informatics

Volumn 79, Issue 6, 2010, Pages 430-437

  Goud, Rick ^a,b   van Engen Verheul, Mariette ^a   de Keizer, Nicolette F ^a   Bal, Roland ^c   Hasman, Arie ^a   Hellemans, Irene M ^a   Peek, Niels ^a  

^a UNIVERSITY OF AMSTERDAM   (Netherlands)

^b Gupta Strategists ^*  (Netherlands)

^c ERASMUS MEDICAL CENTER   (Netherlands)

Author keywords

Cardiac rehabilitation; Clinical decision support systems; Guideline adherence; Qualitative evaluation

Indexed keywords

CLINICAL DECISION SUPPORT SYSTEMS; CLINICAL PRACTICE GUIDELINES; COMPUTERIZED DECISION; CONCEPTUAL FRAMEWORKS; DECISION LOGIC; ENVIRONMENTAL CONSTRAINTS; ENVIRONMENTAL FACTORS; GUIDELINE ADHERENCE; INTERPRETATION OF DATA; QUALITATIVE EVALUATIONS; QUALITATIVE STUDY; SEMI STRUCTURED INTERVIEWS; SYSTEM CHARACTERISTICS;

ARTIFICIAL INTELLIGENCE; HEART;

DECISION SUPPORT SYSTEMS;

ARTICLE; DECISION SUPPORT SYSTEM; HEART REHABILITATION; HUMAN; KINESIOTHERAPY; LIFESTYLE MODIFICATION; MAJOR CLINICAL STUDY; MEDICAL DECISION MAKING; NEEDS ASSESSMENT; OUTPATIENT CARE; PRACTICE GUIDELINE; PRIORITY JOURNAL; QUALITATIVE RESEARCH; QUALITY OF LIFE; REFUSAL TO PARTICIPATE; RELAXATION TRAINING; SEMI STRUCTURED INTERVIEW; AMBULATORY CARE; CORONARY ARTERY DISEASE; OUTPATIENT; STANDARD;

AMBULATORY CARE; CORONARY DISEASE; DECISION SUPPORT SYSTEMS, CLINICAL; GUIDELINE ADHERENCE; HUMANS; OUTPATIENTS; PRACTICE GUIDELINES AS TOPIC;

EID: 77955877788     PISSN: 13865056     EISSN: 18728243     Source Type: Journal    
DOI: 10.1016/j.ijmedinf.2010.03.001     Document Type: Article

References (30)

1. Field M.J., Lohr K.N. Guidelines for Clinical Practice: Directions for a New Program 1990, Institute of Medicine, National Academy Press, Washington, DS.
2. Woolf S.H., Grol R., Hutchinson A., Eccles M., Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999, 318(7182):527-530.
3. Grimshaw J.M., Russell I.T. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993, 342(8883):1317-1322.
4. Grimshaw J., Eccles M., Tetroe J. Implementing clinical guidelines: current evidence and future implications. J. Contin. Educ. Health Prof. 2004, 24(Suppl. 1):S31-S37.
5. Cabana M.D., Rand C.S., Powe N.R., Wu A.W., Wilson M.H., Abboud P.A., et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999, 282(15):1458-1465.
6. Grimshaw J.M., Thomas R.E., MacLennan G., Fraser C., Ramsay C.R., Vale L., et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol. Assess. 2004, 8(6). iii-iv, 1-72.
7. Grol R., Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet 2003, 362(9391):1225-1230.
8. Garg A.X., Adhikari N.K., McDonald H., Rosas-Arellano M.P., Devereaux P.J., Beyene J., et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005, 293(10):1223-1238.
9. 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. 1999, 6(2):104-114.
10. Sonnenberg F.A., Hagerty C.G. Computer-interpretable clinical practice guidelines. Where are we and where are we going?. Yearb. Med. Inform. 2006, 145-158.
11. Kawamoto K., Houlihan C.A., Balas E.A., Lobach D.F. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005, 330(7494):765.
12. Bethell H., Lewin R., Dalal H. Cardiac rehabilitation in the United Kingdom. Heart 2009, 95:271-275.
13. Mazzini M.J., Stevens G.R., Whalen D., Ozonoff A., Balady G.J. Effect of an American Heart Association Get With the Guidelines program-based clinical pathway on referral and enrollment into cardiac rehabilitation after acute myocardial infarction. Am. J. Cardiol. 2008, 101(8):1084-1087.
14. Short R. Access to cardiac rehabilitation varies widely across Europe. BMJ 2008, 336(7653):1095.
15. Rehabilitation Committee NHS/NVVC, Guidelines for Cardiac Rehabilitation, Netherlands Heart Foundation, The Hague, 2004 (available at Accessed 10/16/2007). http://www.hartstichting.nl/Uploads/Brochures/mID_5641_cID_4622_GuidelinesCardiacRehab.pdf.
16. Goud R., Hasman A., Peek N. Development of a guideline-based decision support system with explanation facilities for outpatient therapy. Comput. Methods Program Biomed. 2008, 91(2):145-153.
17. 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. 2009, 78(8):513-520.
18. Goud R., de Keizer N.F., ter Riet G., Wyatt J.C., Hasman A., Hellemans I.M., et al. Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation. BMJ 2009, 338:b1440.
19. Goud R., Jaspers M.W., Hasman A., Peek N. Subjective usability of the CARDSS guideline-based decision support system. Stud. Health Technol. Inform. 2008, 136:193-198.
20. Ash J.S., Smith A.C., Stavri P.Z. Performing subjectivist studies in the qualitative tradition responsive to users. Evaluation Methods in Medical Informatics 2006, 267-300. Springer, New York. C.P. Friedman, J.C. Wyatt (Eds.).
21. de Gucht V., van Elderen T., van der Kamp L., Oldridge N. Quality of life after myocardial infarction: translation and validation of the MacNew Questionnaire for a Dutch population. Qual. Life Res. 2004, 13(8):1483-1488.
22. Friedman C.P., Wyatt J.C. Evaluation Methods in Medical Informatics 2006, Springer, New York. 2nd ed.
23. Greenhalgh T., Taylor R. Papers that go beyond numbers (qualitative research). BMJ 1997, 315(7110):740-743.
24. Kaplan B. Evaluating informatics applications-clinical decision support systems literature review. Int. J. Med. Inform. 2001, 64(1):15-37.
25. Grimshaw J.M., Shirran L., Thomas R., Mowatt G., Fraser C., Bero L., et al. Changing provider behavior: an overview of systematic reviews of interventions. Med. Care 2001, 39(8 Suppl 2):II2-II45.
26. Berg M. Implementing information systems in health care organizations: myths and challenges. Int. J. Med. Inform. 2001, 64(2-3):143-156.
27. Trivedi M.H., Kern J.K., Marcee A., Grannemann B., Kleiber B., Bettinger T., et al. Development and implementation of computerized clinical guidelines: barriers and solutions. Methods Inf. Med. 2002, 41(5):435-442.
28. Turner D.A., Paul S., Stone M., Juarez-Garcia A., Squire I., Khunti K. The cost-effectiveness a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care. Heart 2008, 10.1136/hrt.2007.125708.
29. van der Ploeg I., Winthereik B.R., Bal R. EPRs in the consultation room: a discussion of the literature on effects on doctor-patient relationships. Ethics Inform. Technol. 2006, 8(2):73-83.
30. Tucker A., Edmondson A. Why hospitals don't learn from failures: organizational and psychological dynamics that inhibit system change. Calif. Manage. Rev. 2003, 45(2):55-72.