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THE SWEDISH QUALITY REGISTRIES – Professionals collecting data and publicizing them
Prague 2009-03-05
Dr Karl G Prütz [ kg.prutz@med.lu.se ] Board member of the Swedish Renal Registry [ www.snronline.se ]Department of Nephrology and TransplantationMalmö University Hospital
6
Present situation
Open Comparisons of Health Care Quality in Sweden published yearly since 2006
Large majority of the medical indicators are provided from the >60 national quality registries run by the medical profession
Superior data quality compared to central administrative registries
7
Are there no problems?
More than 60 registries, and increasing Insufficient funding of most registries Inadequate IT-structure – poor
connection to computerized medical records
Many registries have incomplete coverage of patients, clinics and hospitals Uncertain validity of results
8
…no problems? (cont.)
Many important disease groups and health care areas not covered at all Primary care Psychiatry
Strong focus on evidence based processes of care and hard endpoints
Only a few registries have measures of HRQoL or patient satisfaction
9
From the Swedish Renal Registry: Hemodialysis Vascular Access Catheters (VAC) are bad Should only be used as a last resort One of every ten patients with a VAC dies from
complications, mostly septicemia High prevalence of VAC signals deficiencies in
several complex processes of dialysis care …a systematic failure of collaboration between
the renal team (dialysis doctors and nurses), vascular surgery (including lack of operation room capacity), interventional radiology, …
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Hemodialysis Vascular Access Catheter (VAC) use, autumn 2007
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ave
sta
(20
)
Hel
sing
bor
g (
52)
Lju
ng
by (
24)
Lin
köpi
ng
(52)
Yst
ad
(29)
Hal
mst
ad
(26)
Su
nde
rby
(52
)
Lun
d U
SiL
(7
6)
Öst
ers
und
(4
3)
Lun
d H
em
(3
3)
Fal
köpi
ng
(4
2)
Ka
rlst
ad
(1
15)
Mo
tala
(1
8)
Tre
lleb
org
(2
7)
Än
gel
ho
lm (
40)
Ma
lmö
He
lene
holm
(4
0)
Dan
der
yd (
93)
Vä
ster
vik
(29)
Hud
din
ge
(23
6)
Kö
pin
g (
19
)
Pite
å (
15
)
Ske
lleft
eå (
18)
Ka
rolin
ska
(88)
Skö
vde
(5
6)
Eks
jö (
37)
Tot
al (
26
20)
Bo
rås
(63
)
Lyc
kse
le (
12)
Öre
bro
(7
5)
Vä
xjö
(4
2)
Vä
ster
ås
(50)
Häs
sle
holm
(4
1)
Ka
rlsk
rona
(3
2)
Jön
köpi
ng
(4
9)
Ka
lma
r (4
9)
Fal
un
(37
)
Va
rbe
rg (
34)
Ma
lmö
UM
AS
(5
4)
Ka
rlsh
amn
(24
)
Su
ndsv
all
(66
)
NÄ
L (5
9)
Um
eå
(4
2)
Gbg
Lu
ndb
y (7
5)
Gäl
liva
re (
13)
Mo
ra (
32
)
Vis
by (
19)
Gbg
Mö
lnda
l (6
1)
Ka
rlsko
ga
(33)
Bo
llnäs
(4
1)
No
rrkö
pin
g (4
9)
So
llefte
å (
13
)
Gäv
le (
57
)
Upp
sala
(5
7)
Nyk
öp
ing
(2
9)
Esk
ilstu
na
(50
)
Gbg
Öst
ra (
22
)
Gbg
Sa
hlg
rens
ka (
32)
Vä
rna
mo
(28)
Figur 19. Andel med dialyskateter
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Key points
Legislative requirement and support Indicators based on solid evidence Adequate funding (?) Useful for health care management and
resource allocation Useful for health care quality
improvement Useful for patients
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Communication of results
”Everything should be described as simple as possible, but not a bit simpler.”
”Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted.”
Albert Einstein (1879-1955)
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Measuring and improving the quality of healthcare
“…isn't about learning how good you are, but about how bad you are. If you can stop bad things happening, then what remains is better than it was.”
Andrew Moore DSc, Editor of Bandolier http://www.medicine.ox.ac.uk/bandolier/Extraforbando/Waste.pdf
14
Conclusion
No health care system can provide all patients with the best hospitals (or doctors, nurses, …)
Health care systems can make insufficient providers either improve (or close down)
Health Care Quality Registries are an essential component in achieving improvement
15
Additional information
Swedish Quality Registry homepage in english http://www.kvalitetsregister.se/index.php?o
ption=com_content&task=view&id=63&Itemid=592
Official booklet with introduction and descriptions of the 60+ registries http://www.kvalitetsregister.se/images/stori
es/documents/2007_qr.pdf
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