Study protocol: Cost effectiveness of two strategies to implement the NVOG guidelines on hypertension in pregnancy: An innovative strategy including a computerised decision support system compared to a common strategy of professional audit and feedback, a randomized controlled trial
1 Department of Obstetrics and Gynaecology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
2 Department of Health Sciences, Faculty of Earth & Life Sciences, EMGO+ Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV Amsterdam, Netherlands
3 Department of Obstetrics and Gynaecology, St. Elisabeth Hospital, PO Box 90515, 5000 LC Tilburg, Netherlands
4 Department of Obstetrics and Gynaecology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, Netherlands
5 Department of Epidemiology and Biostatistics, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
6 Scientific Institute for Quality of Health Care (IQ healthcare) Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmgen, Netherlands
7 Department of Obstetrics and Gynaecology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, Netherlands
8 Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands
Implementation Science 2010, 5:68 doi:10.1186/1748-5908-5-68Published: 6 September 2010
Hypertensive disease in pregnancy remains the leading cause of maternal mortality in the Netherlands. Seventeen percent of the clinical pregnancies are complicated by hypertension and 2% by preeclampsia. The Dutch Society of Obstetrics and Gynaecology (NVOG) has developed evidence-based guidelines on the management of hypertension in pregnancy and chronic hypertension. Previous studies showed a low adherence rate to other NVOG guidelines and a large variation in usual care in the different hospitals. An explanation is that the NVOG has no general strategy of practical implementation and evaluation of its guidelines. The development of an effective and cost effective implementation strategy to improve adherence to the guidelines on hypertension in pregnancy is needed.
The objective of this study is to assess the cost effectiveness of an innovative implementation strategy of the NVOG guidelines on hypertension including a computerised decision support system (BOS) compared to a common strategy of professional audit and feedback. A cluster randomised controlled trial with an economic evaluation alongside will be performed. Both pregnant women who develop severe hypertension or pre-eclampsia and professionals involved in the care for these women will participate. The main outcome measures are a combined rate of major maternal complications and process indicators extracted from the guidelines. A total of 472 patients will be included in both groups. For analysis, descriptive as well as regression techniques will be used. A cost effectiveness and cost utility analysis will be performed according to the intention-to-treat principle and from a societal perspective. Cost effectiveness ratios will be calculated using bootstrapping techniques.