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Collaboratively improving diabetes care in Sweden using a National Quality Register: Successes and challenges-A Case Study
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Healthcare Department, Region of Jönköping, Jönköping, Sweden.
Center of Registers in Region Västra Götaland, Gothenburg, Sweden.
Center of Registers in Region Västra Götaland, Gothenburg, Sweden.
Sahlgrenska Academy, University of Gothenburg, Sweden.
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2015 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 24, no 4, 2012-221 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Since 1996, the Swedish National Diabetes Register (NDR) enabled health care providers to monitor their clinical performance over time and compare it with the national average. All health systems of Swedish county councils report data. By 2014, the NDR included data from 360 000 patients. Comparisons among county councils show significant variations in clinical outcomes and in adherence to evidence-based national guidelines. The purpose of this study was to evaluate whether and how a quality improvement collaborative could influence clinical practice and outcomes.

METHODS: Twenty-three diabetes teams from all over Sweden, both primary care units and internal medicine departments, joined a quality improvement collaborative. The project was inspired by the Breakthrough Collaborative Model and lasted for 20 months. Evaluation data were collected from the teams' final reports and the NDR throughout the study period.

RESULTS AND CONCLUSION: The teams reported improved patient outcomes significantly compared with the national average for systolic blood pressure and low-density lipoprotein levels. In contrast, glycated hemoglobin A1c levels deteriorated in the whole NDR population. Five themes of changes in practice were tested and implemented. Success factors included improved teamwork, with active use of register data, and testing new ideas and learning from others.

Place, publisher, year, edition, pages
2015. Vol. 24, no 4, 2012-221 p.
Keyword [en]
collaborative, diabetes mellitus, guideline adherence, quality improvement, registries
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-28318DOI: 10.1097/QMH.0000000000000068ISI: 000369965300007PubMedID: 26426323Scopus ID: 2-s2.0-84943428919OAI: oai:DiVA.org:hj-28318DiVA: diva2:871658
Available from: 2015-11-16 Created: 2015-11-16 Last updated: 2016-03-04Bibliographically 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)
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Available from: 2015-11-16 Created: 2015-11-16 Last updated: 2015-11-20Bibliographically approved

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