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Family Practice Vol. 17, No. 2, 180-186
© Oxford University Press 2000

The design and analysis of a randomized controlled trial to evaluate computerized decision support in primary care: the COGENT study

Martin Eccles, Jeremy Grimshawa, Nick Steen, David Parkinb, Ian Purvesc, Elaine McColl and Nikki Rousseau

Centre for Health Services Research, University of Newcastle Upon Tyne, Newcastle Upon Tyne NE2 4AA,
b Department of Epidemiology and Public Health and
c Sowerby Centre for Health Informatics, University of Newcastle Upon Tyne and
a Health Services Research Unit, University of Aberdeen, Aberdeen, UK.

Eccles M, Grimshaw J, Steen N, Parkin D, Purves I, McColl E and Rousseau N. The design and analysis of a randomized controlled trial to evaluate computerized decision support in primary care: the COGENT study. Family Practice 2000; 17: 180–186.

Received 7 September 1999; Accepted 26 October 1999.


   Introduction
 
Despite the current interest in guidelines, there remains uncertainty about how best to introduce them into practice. A systematic review of rigorous published evaluations of the introduction of clinical guidelines1 identified 91 studies covering a wide range of clinical areas including patient management, prevention, test ordering and prescribing; 14 of the studies were conducted in the UK. Eighty-one of the 87 studies measuring the process of medical care identified improvements in the process of medical care; 13 of the 17 papers that measured the outcome of care reported improvements. Nevertheless, there were considerable variations in the range of improvement that possibly was associated with differences in any or all of the following: settings, targeted professional groups, targeted clinical activities, and how the guidelines were developed, disseminated and implemented. The review suggested that one promising method to implement guidelines involved utilizing patient-specific prompts at the time of a consultation. One means . . . [Full Text of this Article]


   Study design
 
Cluster randomization
Balanced incomplete block designs
Before and after design
Study conditions

   The clinical guidelines
 
Guideline development
Guideline dissemination

   Study practices
 

   Sample size
 
Changes in process of care
Changes in outcome of care

   Identification of patients
 

   Medical record-based data collection
 

   Measurement of patient-based outcomes
 

   Economic evaluation
 

   Principles of data analysis
 

   The embedded case studies
 
Conclusions

   Acknowledgments
 

   References
 

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