An innovative implementation strategy to improve the use of Dutch guidelines on hypertensive disorders in pregnancy: A randomized controlled trial

Susanne H.E. Luitjes*, Rosella P.M.G. Hermens, Linda de Wit, Martijn W. Heymans, Maurits W. van Tulder, Maurice G.A.J. Wouters

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

212 Downloads (Pure)


Objective: To evaluate the effectiveness of an innovative strategy to improve implementation of evidence-based guidelines on the management of hypertension in pregnancy compared to a common strategy of professional audit and feedback. Design: Cluster randomized controlled trial (c-RCT). Setting: Sixteen Dutch hospitals. Population: All patients with a hypertensive disorder during pregnancy who were admitted to one of the participating hospitals between April 1st 2010 and May 1st 2011, were suitable for inclusion; the only exclusion criterion was the presence of lethal fetal abnormalities. Methods: Hospitals were randomly assigned to either an innovative implementation strategy including a computerized decision support system (DSS) and professional audit and feedback or a minimal implementation strategy of audit and feedback only. Main outcome measures: Primary outcome measure was a combined rate of major maternal complications. Secondary outcome measures included process-related measures on guideline adherence, and patient-related outcomes. A process evaluation was performed alongside. Results: No statistically significant difference was found in both the occurrence of major complications and most secondary outcome measures between the two groups. Process evaluation showed limited use of the computerized DSS, with a large variation between hospitals (0–49,5% of the eligible patients), but positive experiences of actual users. Conclusion: Using a computerized DSS for implementation of the clinical guidelines for the management of hypertension in pregnancy did not result in fewer major maternal and fetal complications. Limited use of the DSS in the innovative strategy group could be an explanation for the lack of effect.

Original languageEnglish
Pages (from-to)131-138
Number of pages8
JournalPregnancy Hypertension
Early online date27 Sept 2018
Publication statusPublished - Oct 2018


The Netherlands Organization for Health Research and Development ( ZonMw ) funded this project (project no. 170883003). 9 We would like to acknowledge the 16 hospitals and the coordinating gynecologists for their cooperation in data sampling: E.A.M. van den Akker (Onze Lieve Vrouwe Ziekenhuis, Amsterdam), H.P. Oosterbaan (Jeroen Bosch Ziekenhuis, Den Bosch), K.M. Paarlberg (Gelre Ziekenhuis, Apeldoorn), C. Renes-Zeyl (Amstelland Ziekenhuis, Amstelveen), H.G.I. van Weering (Rode Kruis Ziekenhuis, Beverwijk), J.P. Lips (Kennemer Gasthuis, Haarlem), N.W. Schuitemaker and T.E. Vogelvang (Diakonessenhuis, Utrecht), P. Hummel (Medisch Centrum Alkmaar), K. de Boer (Rijnstate Ziekenhuis, Arnhem), R. Kok (Bernhove Ziekenhuis, Oss), I. de Graaf (Spaarne Ziekenhuis, Hoofddorp), J. Persoons (Beatrix Ziekenhuis, Gorinchem), A. Franx and C. van Oirschot (Elisabeth Ziekenhuis, Tilburg), A. Kwee and M. Ouddijk (Univerisitair Medisch Centrum Utrecht, Utrecht), F. Lotgering (Radboud University Medical Centre Nijmegen, Nijmegen) and T. Medema (Bovenij Ziekenhuis, Amsterdam). Furthermore, special thanks to research midwives from the University Medical Centre Utrecht for collecting data. Appendix A

FundersFunder number
Netherlands Organization for Health Research and Development


    • Decision support system
    • Guidelines
    • Implementation
    • Process evaluation
    • Randomized controlled trial


    Dive into the research topics of 'An innovative implementation strategy to improve the use of Dutch guidelines on hypertensive disorders in pregnancy: A randomized controlled trial'. Together they form a unique fingerprint.

    Cite this