Overview of Swedish

Quality Registries

Bertil Lindahl, Bertil Lindahl,

Professor in Cardiology,Professor in Cardiology,

Director of Uppsala Clinical Director of Uppsala Clinical Research center.Research center.

Selective implementation with systematic follow-up

Clinical studies, including RCT.s

Systematic reviews / guidelines

Pre-clinicalresearch

Follow up of outcome and side-effects in clinical routine, nationally and locally

Implementation in clinical routine, nationally and locally

Knowledge based health care

Role for Quality Registries

Outcome research

Clopidogrel

Utbildnings-period

Resultat

Mätning innanprojektstart

Clopidogrel

Utbildnings-period

Resultat

Mätning innanprojektstart

ClopidogrelClopidogrel

Utbildnings-period

Utbildnings-period

ResultatResultat

Mätning innanprojektstart

Mätning innanprojektstart

”I am considered to be eccentric when I officially say that if the hospitals want to be certain to improve, they have to find out what results they have. They have to analyse their results to find strong and weak points. They have to compare their results with others.

These opinions will not be eccentric in a couple of years”.

Ernest Amory Codman MD 1917

Quality registry – no new idea

History of Swedish Quality Registries

Knäplastik; 1975

Höftplastikregistret; 1979

Kärlregistret; 1987

Oxygenregistret; 1987

Höftfrakturregistret; 1988

Pacemakerregistret; 1989

Registret för coronar angioplastik; 1990

Registret för aktiv uremivård; 1990

Swedish Quality Registries 2012

• 4 on level 1

• 20 on level 2

• 49 on level 3

• 27 candidates to become certified registries

73 registries covering a wide range of different interventions and diseases

Three different categories of registries

1. ”interventions”, eg. hip arthroplasty operation or heart surgery

2. ”diagnosis – based on an episode of a certain acute disease”, eg. myocardial infarction or stroke

3. ”diagnosis – chronic diseases”, eg. diabetes or rheumatoid arthritis

Currently ≈70 NationalQ. Registries

The

strategisk styrgrupp operativ beslutsgrupp.expertgrupp referensgrupper

Summary

National Quality RegistriesNational Quality Registries

UCRPatientrecord

Electronic PatientRecord

UCRData

Warehouse

UCRresearch db Publications

NationalHealthDataRegistries

Biobanking

SWEDE HEART

SCAAR

Data entry on line by the phyciansand nurses

SWEDE HEART

SCAAR

On-line reports

Proportion of AMI patients reaching LDL target level one year after AMI

The use of registries for

Research

•Cardiovascular and cancer mortality in very elderly post-myocardial infarction patients receiving statin treatment. J. Am. Coll. Cardiol. 2010;55(13):1362-9.

•Eptifibatide is noninferior to abciximab in primary percutaneous coronary intervention: results from the SCAAR . J. Am. Coll. Cardiol. 2010;56(6):470-5.

•Gender perspective on risk factors, coronary lesions and long-term outcome in young patients with ST-elevation myocardial infarction. Heart. 2010;96(6):453-9.

•Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Cardiovascular Interventions. Eur. Heart J. 2010;31(8):943-57.

•Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery. BMJ. 2010 Jan 19;340:b5606.

Different aspects

•Cardiovascular and cancer mortality in very elderly post-myocardial infarction patients receiving statin treatment. J. Am. Coll. Cardiol. 2010;55(13):1362-9.

•Eptifibatide is noninferior to abciximab in primary percutaneous coronary intervention: results from the SCAAR . J. Am. Coll. Cardiol. 2010;56(6):470-5.

•Gender perspective on risk factors, coronary lesions and long-term outcome in young patients with ST-elevation myocardial infarction. Heart. 2010;96(6):453-9.

•Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Cardiovascular Interventions. Eur. Heart J. 2010;31(8):943-57.

•Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery. BMJ. 2010 Jan 19;340:b5606.

Underutilization of quality

registries for health

economic studies

Costs were assigned using official statistical sources or market prices. Annual costs amounted to US$ 7666 per patient.

Thank you!