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- Hallgren Elfgren, Ing-Marie, et al.
(författare)
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Swedish Diabetes Register, a tool for quality development in primary health care
- 2013
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Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 14:3, s. 250-257
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Tidskriftsartikel (refereegranskat)abstract
- Introduction In Sweden, quality indicators in health care have been the basis for developing National Quality Registers. The Swedish National Diabetes Register (NDR) – one of the largest diabetes registers globally – was introduced in primary health care (PHC) in the county of Östergötland by an implementation project, 2002–2005.Aim The aim of the present paper was to investigate, by using the results of the NDR, whether the registration led to sustained outcomes of medical results of diabetes care in PHC in the county during the period 2005–2009.Method HbA1c, blood pressure (BP), albuminuria and low-density lipoprotein-cholesterol were registered online in the NDR. In 2005 and 2006, goal achievement for HbA1c was measured and compared between PHC centres (PHCC) within the county. In 2007, achievements to national goals were compared between the PHCCs within the county and with those Swedish counties that had attained a sufficiently high registration rate. In 2008 and 2009, the average county results were compared with the corresponding national average measurements for all 21 Swedish counties combined.Result In 2005, a clear improvement trend for HbA1c and BP was shown within the county. In 2007–2009, goal achievements in the county studied were slightly better than the other counties measured and the country as a whole in almost every comparison.Discussion The present study has shown association between medical results and registration in the NDR. As the project was primarily a quality improvement work, the results have continuously influenced the development of diabetes care. Both the health professions and the county council now have – in the NDR – an effective and rapid method for evaluation and follow-up of diabetes care. The systematic documentation, followed by comparisons and analyses, create ideas for care improvements.
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| 2. |
- Hallgren Elfgren, Ing-Marie, et al.
(författare)
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The process of implementation of the diabetes register in Primary Health Care
- 2012
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 24:4, s. 419-424
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Tidskriftsartikel (refereegranskat)abstract
- Quality problem or issue According to Swedish law, all health care units must have a system for quality improvement. The aim of this study was to follow an implementation process of a uniform routine for quality control of diabetes care in Primary Health Care in one county. Initial assessment Primary Health Care had a decentralized organization and patients with type 2 diabetes were served at 42 different Primary Health Care Centres. Choice of solution As the Swedish Diabetes Register (National Diabetes Register, NDR) holds the most important quality indicators, implementation of the NDR registration at all centres was chosen to be the best way to follow up quality in diabetes care. Implementation The process of implementing the NDR went through different phases and the main way to encourage commitment to the process was to reward performance in a progressively more differentiated way. Evaluation During the implementation process (2001–05) there was an increasing rate of registration. When the programme ceased, the registration rate had reached a level of 75%, which has remained stable and was still in 2010 one of the highest rates in Sweden. Lessons learned Important factors for success were the initiative taken by the profession itself and strong support from the leaders of the county council. It was also important to let the process develop gradually in order to get all staff involved. Among the outcomes was an increase in computer use in clinical practice among the diabetes nurse specialists and a structured way of encouraging the patients' participation in self-care.
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| 3. |
- Hallgren Elfgren, Ing-Marie, et al.
(författare)
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The Swedish National Diabetes Register in clinical practice and evaluation in primary health care
- 2016
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Ingår i: Primary Health Care Research and Development. - : CAMBRIDGE UNIV PRESS. - 1463-4236 .- 1477-1128. ; 17:6, s. 549-558
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this project is to describe the use of the Swedish National Diabetes Register (NDR) in clinical practice in a Swedish county and to specifically monitor the diabetes care routines at two separate primary health-care centres (PHCC) with a special focus on older patients. Background: According to Swedish law, all health-care units have to maintain a system for quality evaluation and improvement. As the NDR holds the most important quality indicators, implementation of the NDR in primary care was carried out by an implementation project in 2002-2005. Methods: Initially, a digital questionnaire about NDR routines was sent to all PHCC. Statistics about hemoglobin adult 1c (HbA1c) and blood pressure (BP) was presented for the diabetes teams at two centres who were also interviewed. The responses became the basis for a focus group interview with both teams together, with data subject to content analysis. Findings: The study showed that reporting to the NDR has become a compulsory routine in primary care. The diabetes nurse specialist was responsible for the practical management of the register and used the NDR for continuous monitoring of the patients. Most centres used the NDRs statistics for evaluation and analyses annually. The diabetes nurse adapted the visits to the patients wishes and general condition. Only in terms of target values for HbA1c and BP did they accept slightly higher values for the older patients. Since the NDR was implemented, the registration rate has remained at 75% and has not increased. The reason given was that patients with diabetes living in nursing homes are checked up by the municipal nurse who does not use the NDR. However, the risk of omitting older patients in the NDR could be considerably decreased if data could be transferred from the electronic patient record.
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