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Improving guideline adherence through intensive quality improvement and the use of a National Quality Register in Sweden for acute myocardial infarction
County Council of Jönköping, Sweden.
Department of Clinical Chemistry, Central Hospital, Karlstad, Sweden.
Uppsala Clinical Research, Uppsala, Sweden.
Uppsala Clinical Research, Uppsala, Sweden.
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2007 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 16, no 1, 25-37 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Data from the Swedish National Register in Cardiac Care have shown over the last 10 years an enduring gap between optimal treatment of acute myocardial infarction (AMI) according to current guidelines and the treatment actually given. We performed a controlled, prospective study in order to evaluate the effects of applying a multidisciplinary team-based improvement methodology to the use of evidence-based treatments in AMI, together with the use of a modified National Quality Register. The project engaged 25% of the Swedish hospitals.

METHOD: Multidisciplinary teams from 20 hospitals participating in the National Register in Cardiac Care, ranging from small to large hospitals, were trained in continuous quality improvement methodology. Twenty matched hospitals served as controls. Our efforts were focused on finding and applying tools and methods to increase adherence to the national guidelines for 5 different treatments for AMI. For measurement, specially designed quality control charts were made available in the National Register for Cardiac Care.

RESULTS: To close the gap, an important issue for the teams was to get all 5 treatments in place. Ten of the hospitals in the study group reduced the gap in 5 of 5 treatments by 50%, while none of the control hospitals did so.

CONCLUSIONS: This first, controlled prospective study of a registry supported by multidisciplinary team-based improvement methodology showed that this approach led to rapidly improved adherence to AMI guidelines in a broad spectrum of hospitals and that National Quality Registers can be helpful tools.

Place, publisher, year, edition, pages
2007. Vol. 16, no 1, 25-37 p.
Keyword [en]
Acute Disease, Guideline Adherence, Intensive Care Units, Myocardial Infarction/therapy, Practice Guidelines as Topic, Prospective Studies, Quality Assurance, Health Care/methods/organization & administration, Registries, State Medicine/organization & administration, Sweden
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-17181PubMedID: 17235249ISBN: 1063-8628 (Print) 1063-8628 (Linking) (print)OAI: oai:DiVA.org:hj-17181DiVA: diva2:478587
Available from: 2012-01-16 Created: 2012-01-16 Last updated: 2015-11-16Bibliographically approved
In thesis
1. Learning and understanding for quality improvement under different conditions: An analysis of quality registry-based collaboratives in acute and chronic care
Open this publication in new window or tab >>Learning and understanding for quality improvement under different conditions: An analysis of quality registry-based collaboratives in acute and chronic care
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The demands that are placed on healthcare systems continue to increase, but several studies show that patient care and healthcare system outcomes are not as good as they could be. To come to terms with these problems, many stakeholders turn to systematic quality improvement methods. However, research and practice also shows that change in organisations is difficult. Consequently many quality improvement projects fail. Quality Improvement Collaboratives (QICs), introduced through the use of the Breakthrough series model, represent a commonly used approach. Despite their widespread application, uncertainty remains regarding the effectiveness of QICs. In Sweden, a number of national quality registries document healthcare actions and outcomes for different patient-groups and problem-areas. While these registries have long been used for follow-up purposes and for clinical research, they have not been used extensively for systematic clinical improvement purposes. The overall aim of this thesis was to examine if, and how, QICs which are supported by national quality registries can contribute to quality improvement in the provision of healthcare. The aim was also to examine what learning and new understanding occurred in the application of QICs in different settings.

The empirical material in this thesis comes from three QICs which included participating teams from different hospitals and health centres in Sweden. Each QIC included a national quality registry: the National Quality Registry for Acute Myocardial Infarction Care (RIKS-HIA); the National Diabetes Registry (NDR); and the Swedish Paediatric Diabetes Quality Registry (SWEDIABKIDS).

The thesis draws on an interactive research approach. The data collection and analysis employed both qualitative and quantitative methods. Data fromthe National Quality Registries, final team reports, focus-group interviews, and team members’ experiences were analysed and triangulated.

The studies shows that QICs which are supported by national quality registries helped teams to close a number of gaps between ordinary clinical practice and evidence-based guidelines, thereby contributing to the provision of better care and better clinical outcomes (Study I, Study II, and Study III). Important factors for success included stakeholders’ learning andunderstanding of the organisational context; structures that supported improvement efforts; and team members’ and managers’ commitment to improvement (Study IV). Furthermore, support by an internal team coach also promoted success (Study IV).

This thesis shows how national quality registries can be used in combination with systematic improvement efforts to produce better clinical results. It concludes that different areas of QIC application pose different challenges; for example, addressing care for acute disease versus chronic disease and evaluating professionally influenced process measures versus patient dependent outcome measures. While different organizational contexts and care characteristics can pose challenges to QIC efforts, the formation of “Communities of Practice” during QICs enhanced the learning for improvement with and from others.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2015. 123 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 65
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-28322 (URN)978-91-85835-64-5 (ISBN)
Public defence
2015-12-18, Originalet, Qulturum, Region Jönköpings län, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-11-16 Created: 2015-11-16 Last updated: 2015-11-20Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
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More styles
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  • Other locale
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