EVALUATING SWEDISHQUALITY REGISTERS

BERTIL LINDAHLwww.kvalitetsregister.se

Definition of a National Quality Register (NQR)

• A national quality register contains individualized data concerning patient problems, medical interventions, and outcomes after treatment; within all healthcare production.

• It is annually monitored and approved for financial support by an Executive Committee.

Quality registers

Decision committee

Steering committee

Expertgroup

QR -office

Reference groups

National register service

SoS

Register Centra (RC)

Regional Cancer Centra (RCC)

Vision for NQRs

NQRs are used in an integrated and active way for:

• continuous learning and improvement

• research

• management

to create the best possible health and care together

with the individual.

Evaluating quality of NQRs

• Structure

• Process

• Outcome

The Donabedian model

• Structure– NQR steering committee and chairman

(registerhållare)• good support in health care with good geographical

spread• multiprofessional• patient representatives• CPUA – the legally responsible from the county council

– Access to necessary competences– Appropriate IT-system in place– Well defined quality indicators– System for continuous validation and monitoring

• Process– Data are continuously reported to the registry– Data are validated and the completeness

(täckningsgrad) evaluated– Data are regularly / continuously analyzed and

reported back to • Reporting units• Other stake holders• Used in “open comparisons” (öppna jämförelser)

– Data are delivered and used for:• Local quality improvement• Bench marking• Research

– Results are publically reported on hospital level

• Outcome – Successful improvement of care• Better medical results• Improved patient involvement and patient satisfaction• More equitable care• Lower costs

– Used for management of care at different levels– Successful research• Publication in international journals• Industry collaboration• Innovations

Certification (2014)

• NQR candidate – 24 registers

• NQR level 3 – 52 registers

• NQR level 2 – 22 registers

• NQR level 1 – 7 registers

CURRENT STATUS REPORT SPRING 2014 - for the national investment in NQRs

Report on how the NQRs meet the goals in the different areas

0

50

100

150

200

250

300

350

400

år 2009 år 2010 år 2011 år 2012 år 2013

+ 183 %

Number of articles published in scientific journals

0

5

10

15

20

25

30

35

40

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67

Number of articles/register

External evaluations- the Swedish Agency for Health and Care Services Analysis

Completeness in relation to year of start of the register

Conclusions

• Evaluating the Swedish NQRs is a complex task– Several different types of registers– Several aspects of quality to consider– Various degree of maturity– Various difficult to evaluate the structure, process and

outcome• There has been a substantial positive development of

the quality of the NQRs• Large differences between different NQRs• There are remaining challenges in several areas

Thank you for the attention!