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© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Jönköping Eksjö
Värnamo
Europe
Sweden
Jönköping County
A good life in an attractive region
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
From my bedroom?…No, no but close!
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
International Integrated Care Summit
Lessons from Sweden:
The Esther Project
“Look up” not up
But out – start a
movement of new
integration!
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
• How can we, all together, develop
something called
Horisontal Best Practice?
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
How can I do the best for the patient and facilitate for my care neighbour?
It is the result of the whole systems
that counts..
Exampel 1:
Esther Patientfokuserad
"aktiviteter och delprocesser organiserade efter
prioriterade patientvärden"
Pat asks for prim. care
Investigate Prim. care
treatment hospital
Diagnosis & desition about care/P.c. and hospital
Rehabilitation Prim. care
Treatment hospital
Rehabilitation Municipality
Esther PV-områden (6)
Rehab E R Medicin
Höglandsjukhuset
kommuner (6)
Traditionell "funktionell"
Patient
treatm
finished
pat with
disease
Lab
apotek
Traditional ”functional” Patient focused
”activities and part of processes
organized after prioritated patient
values” Pharmacy
6 municipalities
6 primary care units
Hospital in Eksjö
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
” Esther and a Better life for elderly’’
a lot of opportunities for improvement and redesign
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Does it matter for Lilly?
”More days with energy,
happiness and vitality”.
”You listen to my needs and
together we find out what is
important for me”.
”We put focus on preventive
actions”.
Ref Susanne Lundblad, Senior Alert
Lilly, 95
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
• To find and ”love” the day – Carpe diem
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
A
- Knowledgeable
- Meetings with professional
people and feel that I'm
welcome
-To have a key relationship
- Be seen for who I am
- A personal approach
- Have a linkage to life
Safe care is for me..
Book: ”A Taste of Water”
See the individual every time
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
A poet Tomas Tranströmmer
wrote Further In
On the main road into the city,
When the sun is low
The traffic thickens, crawls
It is a sluggish dragon glittering.
I am one of the dragon’s scales.
Suddenly the red sun is right in the middle of the
windshield streaming in.
I am transparent and a writing becomes visible
inside me - words in invisible ink
That appear when the paper is held to the fire!
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Further in I know I must get far away straight through the
city and then further until it is time to go out
and walk far in the forest.
Walk in the footprints of the badger. It gets
dark, difficult to see.
In there on the moss lie stones. One of the
stones is precious.
It can change everything
It can make the darkness shine.
It is a switch for the whole country.
Everything depends on it.
Look at it, touch it…
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
“You can not visit a world you do
not have a language for.”
Ludwig Wittgenstein
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Involvement, individualisation,
integration, Innovation and information
and fight isolation
• 5 I:s fight
Isolation and
fragmentation
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Creating Shared Value
We get the care we need
when we need it
A redesigned
knowledge
management,
financial
management but
also the patient’s
management
This Sets our minds free
Costs
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Managementsystem in the County
• 13 basic values
• Vision and mission
• 6 overall strategic aims
• A systemmap
• A map of the patients process
• Balanced scorecard
• Patiens safety annual plan
• System to obtain information
• 6 strategic improvement areas
• Actionplan for improvement work
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Övergripande index ÖJ Total index 104 indicators
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Processer Befolkning/patienter
Ekonomi
The overall Trippel Aim
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Inhabitants/patients
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Munici-
pality
Average
days on
sick
leave
(paid
sick
days)
July
2009
Percentage of
19 years old
without dental
caries
2008
Percentage
of 4 year
olds with
overweight
and obesity
Born 2002-
2004
Percen-
tage of
pregnant
women
smoking
2006
Children
per 1000
births
with low
birth
weight
2005-2007
Percen-
tage of
inhabitants
with good
self-
perceived
health
(W/M)
Percen-
tage of
inhabitants
with high
alcohol
consumpti
on (W/M)
Jönköp-
ing
31,5 30%-53% 14,6% 5,8% 32,7 65/73 7/14
Habo 28,4 35% 12,9% 9,2% 21,6 73/74 6/15
Mullsjö 37,7 30% 16,4% 9,6% 28,1 73/67 7/14
Tranås 39,0 42% 12,6% 9,1% 20,3 69/73 7/22
Aneby 34,5 48% 16,3% 10,9% 58,8 68/70 7/13
Eksjö 35,0 48%-59% 13,8% 9,3% 22,8 67/70 5/14
Nässjö 35,4 28%-30% 13,9% 9,8 % 21,7 68/75 6/15
Sävsjö 35,2 41%-54% 12,5% 8,4% 20,4 70/67 8/8
Vetlanda 33,4 35%-42% 15,8% 8,8% 39,2 72/73 9/14
Gislaved 31,3 33%-35% 16,9% 13,6% 33,8 71/73 7/14
Gnosjö 29,2 29% 15,8% 8,9% 32,9 74/72 10/12
Vaggeryd 29,0 28% 14,3% 6,7% 35,6 72/70 9/14
Värnamo 26,7 27-38% 15,3% 8,8% 23,4 76/75 5/11
County 32,0 38% 14,7% 8,1 30,1 70/73 7/14
Sweden 34,1 -** - 7,5 31,1 67/69 10/16
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Mothers that smoke while pregnant (in procent)
10,5
8,5
8,2
8,1
7,3
5,5
9
12
8,7
9,1
6,3
13,7
11,5
7,6
8,1
6
12,6
9,2
12,6
9,7
11,1
8,8 11,6
12,2
5,7
5,2
9,7
11,9
9,4
9,5
14,1
12,9
8,9
6,3
9,8
8,7
8,2
8,6
Andel (%) rökande bilvande mödrar
5,2-8,1 (10)
8,2-11,5 (19)
11,6-14,1 (9)
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Singapore •Few young •Few elderly
Sweden •Few young •A lot of elderly
USA •Many young •Elderly
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
We are in Sweden:
2011: 1.75 million people over 65, approx 800 000 over 75
2020; 2,1 million people over 65 och 995 000 over 75
’’In a European perspective Sweden are in the top in self perceptive
health among people over the age 85’’
Resource;Salar
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
23
Amount of hospital days/year for
the most ACG heavy patients
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
A new”mindset”
From planning and talking to… it is the
systems results that counts
in a complex content
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
25
Dependent
Independent
Co - dependent
Singel Integrator
Independent inter
Source: Stephen Covey and Bill Tolbert, Adapted
Many Co-Integrators:
A modernized Municipality Model
Vertical Integration
Horisontal Integration
O
w
n
e
r
s
h
i
p
Vision, Principles, Collaborative, Trustable
Arrangements
Challenge Vertical or Network Model?
Network Model
Businessmodel
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Gaps challenges but also opportunities
• Public health and prevention
• Integrated care elderly, children, chronic care
• Primary care reform – Inhabitant choice
• Advanced access
• Individualization
• Reliability and “Open comparison”
• Patient safety
• Practice to research and back
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Involvement, individualisation,
integration, Innovation and information
and fight isolation
• 5 I:s fight
Isolation and
fragmentation
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Order your chlamydia test
over the web!
- To reach young people
- The amount of men that do
the test should increase
compared with men at the
hospitals office
- Easy reachable from our
web.
- Do a good design in
marketing that support the new
way.
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
29
Safer Care with eHealth as a method
Planned
preventive
actions
on the web
site:
”My
Healthcare
Contacts”
In logged as
Dr Test Testman
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
30
Safer Care with eHealth as a method
Start
Your
answers
Completed
actions
In logged as
Dr Test Testman
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Using evidence-based
instruments for each patient ≥
65 years to diagnose
risk of pressure sores,
malnutrition or fall
Patients at risk are
investigateed and a plan
for preventive measures
All patients registered in
the registry - Senior Alert -
which is available in all
hospitals, primary care
and in the municipality .
Evaluation of results
is done in a clinical
registry -
Senior alert
A Care preventive process
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
34
John is a patient with the risk of falling.
He has a plan with preventive actions
Risk assessment, preventive actions and
outcomes are registered in the clinical
register “Senior alert”. This is done
by professionals at the ward, homes
for elderly etc; in the healthcare
(hospitals, primary care) and in
the community.
In the future John can
register his data by
himself at home.
And he will
meet us on
the web!
He will use an app!
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Evidence – actions - feedback
Register in Senior alert
Systematic
approach in daily work
Improvements
Reflections and outcomes
IT-support
Fascilitation
Manuals
Risk? Actions? Results?
Vad vill vi åstadkomma?
Hur vet vi att en förändring är en förbättring?
Vilka förändringar kan leda till en förbättring?
Mål !
Mått !
Idéer !
Test !
Agera Planera
Göra Studera
PGSA-cirkeln
Amount of careplan in patients with risk
0%20%40%60%80%
100%
jan-10
feb-10
mar-10
apr-10
maj-10
jun-10
jul-10
aug-10
sep-10
okt-10
nov-10
dec-10
jan-11
feb-11
mar-11
apr-11
maj-11
jun-11
jul-11
aug-11
sep-11
okt-11
nov-11
dec-11
Hospital 1 Hospital 2 Hospital 3 County council Target
Learning from results
5P Purpose
Patient
People - personal
Processer
Patterns - mönster
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
36
Pre-diagnosis Diagnosis &
treatment
Follow-up &
monitoring
End of
life care
Diet?
Risk assessment?
Screening?
Pt. education?
Colonoscopy?
Biopsy?
Staging?
Surgery?
Colostomy?
Radiation?
Chemotherapy?
Pt. education?
Shared decision-making?
Colostomy care?
Cancer activity?
Pt. education?
Shared decision-
making?
Palliative care?
Pt. education?
Shared decision-
making?
ACTIVITIES
Screening events?
Prevalence?
Pt. awareness?
Stage at diagnosis?
Treatment algorithm?
Complications?
Pt. understanding,
satisfaction?
Q,S,V measures?
Survival length?
Activities of daily living?
Monitoring algorithm?
Complications?
Pt. understanding,
satisfaction?
Pain control?
Good death?
Family help?
MEASURES Draft
Jan, 2010
pbb
Zone of
greatest
attention
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Promises by the board of the “Regional Cancer
Center South East” WE PROMISE THAT: GOAL GOAL 2012b
You do not have to wait more than
4 weeks the most before investigation
and adequate treatment for cancer
Contact with healthcare
- diagnosis 2 weeks
Diagnosis – treatment 2 weeks
T ½
T ½
You are offered diagnostic and
treatment for your cancer according
to ”best practice”
We must have Care program (CP) for
90 % of tomours.
Commitment to the CP we have 80%
T ½
T ½
You are well informed / taking part
in the whole care chain
Time schedule to next step shall be
offered at every healthcare contact
80 %
You who are in the end of life will h
have the same good care where
ever you live in the region
Access to palliative care.
24 hours after breakpoint
T ½
No difference between different
inhabitant groups in the region
when getting cancer
Smoking reduced in youth groups
Coverage screening
program X %
T ½
T ½
Health care prioritizes patient close
research within the area cancer.
Share/part of cancer patients that
will enter into research projects
T ½
T½= Halving the gap from to day’s result to the goal. E.g. current status 30 d, goal14 d.
T½ = 22 days before Dec. 31th 2012.
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
39
Symtom
Behandling/åtgärd
Information
Undersökningbedömninguppföljning
Kompetens
Första symtomFörsta symtom Första kontaktFörsta kontaktPatientens sammanhangPatientens sammanhang
Patient
Patienters
individuella
preferenser
Patient
Patientens sammanhangPatientens sammanhang
Patientcentrerad processkartläggning för ____________________________________
Symtom
Behandling/åtgärd
Information
Undersökningbedömninguppföljning
Kompetens
Patientcentrerad processkartläggning för ____________________________________ Patientcentrerad processkartläggning för ____________________________________
Första symtomFörsta symtom Första kontaktFörsta kontakt UtredningUtredning Beslut om åtgärdBeslut om åtgärd Behandling/åtgärdBehandling/åtgärdPatientens sammanhangPatientens sammanhang Patientens sammanhangPatientens sammanhang Patientens sammanhangPatientens sammanhang Patientens sammanhangPatientens sammanhang
Patient
vilka ytterligare kompetenser
behövs i detta steg?
vilka ytterligare kompetenser
behövs i detta steg?
Patientens sammanhangPatientens sammanhang
Patientens
fysiska,
psykiska,
sociala och
existentiella
behov
Patient Patient Patient Patient
Patientens sammanhangPatientens sammanhang UppföljningUppföljning Patientens sammanhangPatientens sammanhang
Patient
The Patient’s Process
Patient’s context First symtom Patient’s context First contact
The patient’s
individual
preferences
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
• Multi discipline Team
• Design the process
with everybody
involved
• Patient’s diary
• Start data analyze
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
41
Tid från remiss för utredning på grund av misstänkt koloncancer till behandling (operation, onkologisk behandling, palliativ vård)
Landstinget i Östergötland, Regionalt cancercentrum Sydöst
2011
medel=49 dagar
0
20
40
60
80
100
120
sep sep sep okt okt okt okt nov nov nov nov dec dec dec dec dec
From Referral to Treatment
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
ERAS
Epidural
Anaesthesia
Prevention
of ileus/
prokinetics
CHO - loading/
no fasting
Early
mobilisation
Peri-op fluid
management
DVT
prophylaxis
Pre-op councelling
Remifentanyl
No - premed
No bowel prep
Perioperative
Nutrition
Bairhugger
Oral analgesics/
NSAID’s
Incisions
No NG tubes
Early removal
of catheters/drains
Lassen et al, Arch Surg, 2009
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
”Matchmaking”
Same need?
Same situation?
Same individual choice?
What is best
care for each
of them
Ref Per-Anders Heedman
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
Fraction of record
notes about
(se below)
was measures:
Medical plan
Social plan
Care level
Handover
according
to SBAR
Baseline for proportion of patients having their medical plan
outwritten in their record note of the Medical Department in Eksjö,
Jönköping County, Sweden
0,00
0,20
0,40
0,60
0,80
1,00
1,20
14-0
3-201
1
16-0
3-201
1
18-0
3-201
1
22-0
3-201
1
24-0
3-201
1
28-0
3-201
1
30-0
3-201
1
01-0
4-201
1
05-0
4-201
1
07-0
4-201
1
Date
Fra
cti
on
Percent
p-bar
LCLp
UCLp
Baseline for proportion of patients beeing assessed bedside at the
Medical Department in Eksjö, Jönköping County, Sweden
0,00
0,20
0,40
0,60
0,80
1,00
14-0
3-201
1
16-0
3-201
1
18-0
3-201
1
22-0
3-201
1
24-0
3-201
1
28-0
3-201
1
30-0
3-201
1
01-0
4-201
1
05-0
4-201
1
07-0
4-201
1
datum
fracti
on
Percent
p-bar
LCLp
UCLp
Current status
The “ward round” is a central activity of a
hospital ward. It is often proceeded by the
doctor and the responsible nurse, in the
corridor or in an office before meeting the
patient bedside. This was also the tradition
of the gastroenterological ward at the
Highland Hospital in Eksjo, Jonkoping
County, Sweden. We perceived that this
format did not fulfil the requirements for
high quality care. Each patient was to
been seen individually in a separate office,
when needed, by a multi professional
team.
The aim of the redesign is to enhances
patient privacy, empowerment and inter-
professional communication. By this
increasing the value of the care offered as
well as lowering the cost for this central
activity of hospital care.
Baseline for proportion of patients having their care level assessent
and noted in their record at the Medical Department in Ekjsö,
Jönköping County, Sweden.
0,00
0,20
0,40
0,60
0,80
1,00
14-0
3-201
1
16-0
3-201
1
18-0
3-201
1
22-0
3-201
1
24-0
3-201
1
28-0
3-201
1
30-0
3-201
1
01-0
4-201
1
05-0
4-201
1
07-0
4-201
1
Date
Fra
cti
on
Percent
p-bar
LCLp
UCLp
Economics
In tests the time
needed for the
ward round was
decreased with
approximately 8
minutes.
Upscaled to a
Department level
this equals 300-
400000 dollars a
year of savings
Also see www.lj.se/ronden
The transition of the ward round from a “parade”
to a round table consultation
New status
Rapid improvement cycles were
adapted in a multifaceted strategy.
Hand overs were structured according
to SBAR. Baseline measures for notes
about the assessment of medical,
social and care level was performed as
well as for the time needed for the two
ward round formats.
The intended redesign became the
daily routine of the ward. Preliminary
results show possible improvements
for the value of the offered care as well
as time savings.
Staff reports “Today every one in the
staff knows what is going to happened
the coming day” pointing to a better
interprofessional communication.
“Today every one in the staff knows what
is going to happened the coming day” staff
33 min
41 min
© Göran Henriks
Jönköping County Council
www.lj.se/qulturum
0
5
10
15
20
25
30
35
40
2008 Tertial 1 Tertial 2 Tertial 3 2009 Tertial 1 Tertial 2 Tertial 3 2010 Tertial 1 Tertial 2
Pati
en
tskad
or
per
tusen
vård
dag
ar
Höglandets Sjukvårdsområde Jönköpings Sjukvårdsområde Värnamo Sjukvårdsområde Landstinget
0
5
10
15
20
Maj 2008 November 2008 April 2009 November 2009 April 2010 November 2010
Pro
cen
t
Höglandets Sjukvårdsområde Jönköpings SjukvårdsområdeVärnamo Sjukvårdsområde Mål
Resultatmått Processmått
Påverkansanalys Säker vård – alla gånger Mars 2011 (uppdaterad 110426)
Följsamhet till riktlinjer basala hygienrutiner Punktprevalensmätning Vårdrelaterade infektioner (PPM VRI) Följsamhet Område 3 Förebygg läkemedelsfel vid
vårdens övergångar. Mål:100 procent
Förebyggande bedömningar före operation Vårdprevention – Riskbedömning av fall, nutrition och trycksår
Patientskador per 1000 vårddagar (AE)
0
10
20
30
40
50
60
70
80
90
100
Oktober 2008 April 2009 Oktober 2009 April 2010 Oktober 2010
Pro
ce
nt
Jönköpings Sjukvårdsområde Höglandets Sjukvårdsområde Värnamo Sjukvårdsområde Mål
Mål: Säker Vård
alla gånger
Övergripande
resultatmått:Antal patientskador
per 1000 patientdygn
Primära drivkrafter
Följsamhet område 3 och 7
Sekundära drivkrafter
Undvik
Vårdrelaterade
infektioner
Följsamhet Basala
Hygienrutiner och Rätt Klädd
Följsamhet område 9 och 14
Följsamhet område 4, 5, 6, 8,
10 och 13
Undvik
Läkemedelsrel
patientskador
Undvik Fall och
trycksår
Tillförlitlig
Hjärtsjukvård Följsamhet område 2 och 11
Följsamhet omr 12
Följsamhet omr 1
Stödjande
ledarskap
Följsamhet riktlinjer ”KAD bara när det behövs”
0
10
20
30
40
50
60
70
80
90
100
jan
ua
ri
feb
rua
ri
ma
rs
ap
ril
ma
j
jun
i
juli
au
gu
sti
sep
tem
be
r
okto
be
r
no
vem
be
r
de
cem
be
r
jan
ua
ri
feb
rua
ri
ma
rs
ap
ril
ma
j
jun
i
juli
au
gu
sti
sep
tem
be
r
okto
be
r
no
vem
be
r
de
cem
be
r
jan
ua
ri
feb
rua
ri
ma
rs
n=6 n=4 n=8 n=7 n=10 n=8 n=6 n=8 n=14 n=13 n=11 n=16 n=19 n=18 n=20 n=26 n=26 n=21 n=18 n=20 n=26 n=29 n=31 n=30 n=31 n=26 n=24
Månad 2009-2011 (n=antal mätande enheter i Landstinget)
Pro
cen
tue
ll a
nd
el
Höglandets Sjukvårdsområde Jönköpings Sjukvårdsområde Värnamo Sjukvårdsområde
Månad
AD
E p
er
do
s
decokt
aug
jun
apr
feb
decokt
aug
jun
apr
feb
deco kt
aug
jun
apr
feb
deco kt
aug
jun
apr
feb
decokt
aug
jun
apr
feb
decokt
aug
jun
apr
feb
decokt
aug
jun
apr
feb
decokt
aug
jun
0,006
0,005
0,004
0,003
0,002
0,001
0,000
_U=0,003058
UCL=0,005282
LCL=0,000835
20032004 2005 2006 2007 2008 2009 20101
11
11
Tests performed with unequal sample sizes
Läkemedelsrelaterade patientskador (ADE), genomsnitt 3,1 ADE per 1000 doser
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
jan-1
0
feb-1
0
mar-
10
apr-
10
maj-10
jun-1
0
jul-10
aug-1
0
sep-1
0
okt-
10
nov-1
0
dec-1
0
jan-1
1
feb-1
1
mar-
11
%
Höglandets sjukvårdsområde på op enhet Jönköpings sjukvårdsområde på op enhet Värnamo sjukvårdsområde på op enhet Mål
50%
60%
70%
80%
90%
100%
110%
jan
-09
feb
-09
ma
r-09
ap
r-09
ma
j-09
jun
-09
jul-0
9
au
g-0
9
se
p-0
9
okt-0
9
no
v-0
9
de
c-0
9
jan
-10
feb
-10
ma
r-10
ap
r-10
ma
j-10
jun
-10
jul-1
0
au
g-1
0
se
p-1
0
okt-1
0
no
v-1
0
de
c-1
0
jan
-11
feb
-11
ma
r-11
ap
r-11
ma
j-11
jun
-11
jul-1
1
au
g-1
1
se
p-1
1
okt-1
1
no
v-1
1
de
c-1
1
Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde
Totalt i länet Mål
60
65
70
75
80
85
90
95
100
se
p-0
8
okt-0
8
no
v-0
8
de
c-0
8
jan
-09
feb
-09
ma
r-09
ap
r-09
ma
j-09
jun
-09
jul-0
9
au
g-0
9
se
p-0
9
okt-0
9
no
v-0
9
de
c-0
9
jan
-10
feb
-10
ma
r-10
ap
r-10
ma
j-10
jun
-10
jul-1
0
au
g-1
0
se
p-1
0
okt-1
0
no
v-1
0
de
c-1
0
jan
-11
feb
-11
ma
r-11
ap
r-11
ma
j-11
jun
-11
jul-1
1
au
g-1
1
se
p-1
1
okt-1
1
no
v-1
1
de
c-1
1
Jönköpings sjukvårdsområde Höglandets sjukvårdsområde Värnamo sjukvårdsområde FolktandvårdMedicinsk diagnostik Primärvård Mål
