Building an infrastructure to improve

cardiac rehaBilitation:

from guidelines to audit and feedBack

mariëtte m. van engen-verheul

colofon

Building an infrastructure to improve cardiac rehabilitation: from guidelines to audit and

feedback.

PhD thesis, University of Amsterdam, Amsterdam, the Netherlands.

ISBN 978-94-91602-43-6.

Lay out and printed by Print Service Ede BV (www.proefschriftenprinten.nl).

Cover design by Studio Kinrooi (http://studiokinrooi.nl).

Photo at back of the cover by Minke Kersten.

Financial support by the Dutch Heart Foundation for the publication of this thesis is gratefully

acknowledged. Furthermore we are very grateful for the financial support provided by Medecs

BV, and Furore BV towards the publication of this thesis.

Copyright © 2016, Mariëtte M. van Engen-Verheul, Amsterdam, the Netherlands.

All rights reserved. No part of this thesis may be reproduced, stored or transmitted in any form

or by any means without prior written permission of the author. A digital version of this thesis

can be found at http://dare.uva.nl.

The research described in this thesis was carried out at the Department of Medical Informatics,

Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands. The work

was financially supported by ZonMw (The Netherlands Organisation for Health Research and

Development) for the CARDSS-II project number 170883002, by SAG (Stichting Achemea

Gezondheid) for the CARDSS Online project number 3200606 and by the Department of

Medical Informatics, Academic Medical Center/ University of Amsterdam.

Building an infrastructure to improve

cardiac rehaBilitation:

from guidelines to audit and feedBack

academisch proefschrift

ter verkrijging van de graad van doctor

aan de Universiteit van Amsterdam

op gezag van de Rector Magnificus

prof. dr. D.C. van den Boom

ten overstaan van een door het College voor Promoties ingestelde commissie,

in het openbaar te verdedigen in de Aula der Universiteit

op woensdag 30 maart 2016, te 13:00 uur

door mariëtte mijntje verheul

geboren te Maarssen

promotiecommissie

promotores: Prof. dr. N.F. de Keizer Universiteit van Amsterdam

Prof. dr. M.W.M. Jaspers Universiteit van Amsterdam

copromotores: Dr. N.B. Peek University of Manchester

Dr. H.M.C. Kemps Máxima Medisch Centrum

overige leden: Prof. dr. A. Abu Hanna Universiteit van Amsterdam

Prof. dr. R.J.G. Peters Universiteit van Amsterdam

Prof. dr. F. Nollet Universiteit van Amsterdam

Prof. dr. M.J. Schalij Universiteit Leiden

Dr. A. de Rijk Universiteit Maastricht

faculteit der geneeskunde

“het hart van de mens overdenkt zijn weg,

maar de heer bepaalt de richting die hij gaat”

Spreuken 16:9

voor mijn ouders

taBle of contents

Chapter 01. Introduction, aims and outline

part i improvement challenges in the field of cardiac rehabilitation

Chapter 02. The effect of computerized decision support on barriers to guideline

implementation: a qualitative study in outpatient cardiac rehabilitation

Chapter 03. Design of a continuous multifaceted guideline-implementation strategy

based on computerized decision support

Chapter 04. Cardiac rehabilitation uptake and its determinants in the Netherlands

part ii an infrastructure to facilitate continuous improvement

Chapter 05. Optimizing the user Interface of a data entry module for an electronic

patient record for cardiac rehabilitation: a mixed method usability approach

Chapter 06. Revision of the Dutch clinical algorithm for assessing patient needs in

cardiac rehabilitation based on identified implementation problems

Chapter 07. Modified rand method to derive quality indicators: a case study in cardiac

rehabilitation

Chapter 08. A web-based system to facilitate local, systematic quality improvement by

multidisciplinary care teams: development and first experiences of CARDSS

Online

part iii effect of a web-based audit and feedback system with outreach visits

Chapter 09. 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.

Chapter 10. Improving guideline concordance in multidisciplinary teams: preliminary

results of a cluster-randomized trial evaluating the effect of a web-based

audit and feedback intervention with outreach visits

Chapter 11. Effect of a web-based audit and feedback intervention with outreach

visits on clinical performance of multidisciplinary teams: a cluster-

randomized trial in cardiac rehabilitation

Chapter 12. What is needed to implement a web-based audit and feedback intervention

with outreach visits to improve care quality: a concept mapping study

among cardiac rehabilitation teams

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Chapter 13. Summary and General discussion

Chapter 14. Samenvatting

PhD portfolio & Publications

Curriculum Vitae

Dankwoord