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

The overall aim of this thesis is to use the principles of the Learning Health System (LHS) to realise an infrastructure to connect physicians, other health professionals, managers, professional associations, electronic patient record (EPR) developers, patients and researchers to continuously improve professional performance in the field of cardiac rehabilitation (CR) in the Netherlands. CR programs offer a cost-effective, multidisciplinary, comprehensive approach to address coronary heart disease risk factors and to support patient in restoring their optimal physical and psychosocial condition.
The infrastructure we developed integrates both technical and organisational components. The technical components allow the co-use of data collected in the EPR with clinical decision support (CDS), and realised an web-based audit and feedback (A&F) system. The organisational components concerned the active involvement of all stakeholders to receive their necessary input and commitment for the optimal functioning of the technical infrastructure. In addition we offered support services for multidisciplinary CR teams during outreach visits to actually use the A&F system and improve their performance by executing the LHS learning cycle.
In the Introduction we addressed three research aims:
1) To assess current improvement challenges in the field of CR
2) To develop an infrastructure to facilitate continuous improvement
3) To assess the effect of a web-based A&F system with outreach visits on professional performance
In Chapter 13 we present a summary and discussion of the main findings for each aim followed by our recommendations for researchers, decision-makers and other stakeholders from both inside and outside the field of CR.