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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

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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

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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

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…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

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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

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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

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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