Evidence map›Paper›PMID 19398471›Full record

Trial reportBMJ (Clinical research ed.)2009

Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation.

Rick Goud, Nicolette F de Keizer, Gerben ter Riet, Jeremy C Wyatt, Arie Hasman, Irene M Hellemans, Niels Peek

Erratum issuedAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 34 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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  19. Partner-developed electronic health record tools to facilitate social risk-informed care planning.Journal of the American Medical Informatics Association : JAMIA · 2023
    Article
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4 · The record

Corrections and comments

  • Erratum issued
5 · Who and what money

Authors and funding

7 authors.

Rick GoudDepartment of Medical Informatics, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1100 DD, Amsterdam, Netherlands.
Nicolette F de Keizer
Gerben ter Riet
Jeremy C Wyatt
Arie Hasman
Irene M Hellemans
Niels Peek

Funding

Medical Research Council MC_PC_13042Medical Research Council MR/K006665/1
6 · The paper itself

Abstract

objectiveTo determine the extent to which computerised decision support can improve concordance of multidisciplinary teams with therapeutic decisions recommended by guidelines.

designMulticentre cluster randomised trial.

participantsMultidisciplinary cardiac rehabilitation teams in Dutch centres and their cardiac rehabilitation patients.

interventionsTeams received an electronic patient record system with or without additional guideline based decision support.

main outcome measuresConcordance with guideline recommendations assessed for two standard rehabilitation treatments-exercise and education therapy-and for two new but evidence based rehabilitation treatments-relaxation and lifestyle change therapy; generalised estimating equations were used to account for intra-cluster correlation and were adjusted for patient's age, sex, and indication for cardiac rehabilitation and for type and volume of centre.

resultsData from 21 centres, including 2787 patients, were analysed. Computerised decision support increased concordance with guideline recommended therapeutic decisions for exercise therapy by 7.9% (control 84.7%; adjusted difference 3.5%, 95% confidence 0.1% to 5.2%), for education therapy by 25.7% (control 63.9%; adjusted difference 23.7%, 15.5% to 29.4%), and for relaxation therapy by 25.5% (control 34.1%; adjusted difference 41.6%, 25.2% to 51.3%). The concordance for lifestyle change therapy increased by 3.2% (control 54.1%; adjusted difference 7.1%, -2.9% to 18.3%). Computerised decision support reduced cases of both overtreatment and undertreatment.

conclusionsIn a multidisciplinary team motivated to adopt a computerised decision support aid that assists in formulating guideline based care plans, computerised decision support can be effective in improving the team's concordance with guidelines. Therefore, computerised decision support may also be considered to improve implementation of guidelines in such settings.

trial registrationCurrent Controlled Trials ISRCTN36656997.

Indexed as

Decision Making, Computer-AssistedExercise TherapyPatient Care TeamPatient Education as TopicRelaxation TherapyCluster AnalysisDecision Support Systems, ClinicalFemaleGuideline AdherenceHeart DiseasesHumansMaleMiddle AgedPractice Guidelines as TopicTreatment Outcome

Identifiers

PMID19398471
PMCPMC2674147

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.