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| 2. |
- Anderzen, J., et al.
(författare)
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Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults
- 2016
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Ingår i: Journal of Diabetes and Its Complications. - : Elsevier BV. - 1056-8727 .- 1873-460X. ; 30:3, s. 533-536
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To evaluate how HbA1c in adolescents with type 1 diabetes affects microvascular complications in young adults. Methods: All individuals registered in the Swedish paediatric diabetes quality registry (SWEDIABKIDS) 13-18 years of age, and as adults registered in the Swedish National Diabetes Registry (NDR) in both the years 2011 and 2012 were included, in total 4250 individuals. Results: Of the individuals with mean HbA1c >78 mmol/mol in SWEDIABKIDS 83.4% had retinopathy, 15.8% had microalbuminuria and 4.9% had macroalbuminuria in NDR. The logistic regression analysis showed that the OR to develop macroalbuminuria as a young adult was significantly higher in the group with mean HbA1c >78 mmol/mol in SWEDIABKIDS (p < 0.05). Among the patients with mean HbA1c above 78 mmol/mol in both registries there was a significantly higher proportion that had retinopathy, microalbuminuria (p < 0.001) and/or macroalbuminuria (p < 0.01) compared to the group with HbA1c below 57 mmol/mol in both registries. Only 6.5% of the persons in this study were over 30 years of age. Conclusions: Paediatric diabetes teams working with teenagers must be aware of the impact of good metabolic control during adolescence, and should intensify the care during this vulnerable period of life to reduce the risk of microvascular complications in young adults.
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| 4. |
- Charalampopoulos, Dimitrios, et al.
(författare)
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Exploring Variation in Glycemic Control Across and Within Eight High-Income Countries: A Cross-sectional Analysis of 64,666 Children and Adolescents With Type 1 Diabetes
- 2018
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Ingår i: Diabetes Care. - : AMER DIABETES ASSOC. - 0149-5992 .- 1935-5548. ; 41:6, s. 1180-1187
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE International studies on childhood type 1 diabetes (T1D) have focused on whole-country mean HbA(1c) levels, thereby concealing potential variations within countries. We aimed to explore the variations in HbA(1c) across and within eight high-income countries to best inform international benchmarking and policy recommendations. RESEARCH DESIGN AND METHODS Data were collected between 2013 and 2014 from 64,666 children with T1D who were amp;lt; 18 years of age across 528 centers in Germany, Austria, England, Wales, U.S., Sweden, Denmark, and Norway. We used fixed-and random-effects models adjusted for age, sex, diabetes duration, and minority status to describe differences between center means and to calculate the proportion of total variation in HbA(1c) levels that is attributable to between-center differences (intraclass correlation [ICC]). We also explored the association between within-center variation and childrens glycemic control. RESULTS Sweden had the lowest mean HbA(1c) (59mmol/mol [7.6%]) and together with Norway and Denmark showed the lowest between-center variations (ICC amp;lt;= 4%). Germany and Austria had the next lowest mean HbA(1c) (61-62 mmol/mol [7.7-7.8%]) but showed the largest center variations (ICC similar to 15%). Centers in England, Wales, and the U.S. showed low-to-moderate variation around high mean values. In pooled analysis, differences between counties remained significant after adjustment for children characteristics and center effects (P value amp;lt; 0.001). Across all countries, children attending centers with more variable glycemic results had higher HbA(1c) levels (5.6mmol/mol [0.5%] per 5mmol/mol [0.5%] increase in center SD of HbA(1c) values of all children attending a specific center). CONCLUSIONS A tsimilar average levels of HbA(1c), countries display different levels of center variation. The distribution of glycemic achievement within countries should be considered in developing informed policies that drive quality improvement.
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| 5. |
- Hanberger, Anders, et al.
(författare)
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Audit and Accountability
- 2017
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Ingår i: Blom, B., Evertsson, L. & Perlinski, M. (Eds.) Social and Caring Professions in European Welfare States.. - Bristol, UK. : Policy Press. - 9781447327196
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Bokkapitel (refereegranskat)
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| 6. |
- Hanberger, Anders, 1953-, et al.
(författare)
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Auditing and accountability
- 2017
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Ingår i: Social and caring professions in European welfare states. - Bristol : Policy Press. - 9781447327196 ; , s. 83-97
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Bokkapitel (refereegranskat)abstract
- This chapter consists of two parts. First, two accountability dilemmas are identified, key concepts are defined, and a framework for exploring the interplay among democratic governance, audit systems, and accountability is presented. Second, two different but dominant audit systems used in Swedish eldercare are described and analysed in light of this framework, and consequences of auditing and accountability for key actors involved are discussed, as well as possible ways of resolving the two accountability dilemmas. In relation to the volume, this chapter explores conditions, trends, and challenges in today's audit society and their implications for welfare professions and other key actors. Swedish eldercare is an illustrative case of a phenomenon occurring in most policy sectors.
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| 7. |
- Hanberger, Anders, 1953-, et al.
(författare)
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Evaluation of Swedish eldercare : a local perspective
- 2016
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Konferensbidrag (refereegranskat)abstract
- Many countries institutionalize evaluation systems at different levels of governance to enhance quality in eldercare. In Sweden, which is the focus of this paper, the Health and Social Care Inspectorate (IVO) (www.iwo.se) is responsible for improving quality in eldercare through state supervision, and the National Board of Health and Welfare (www.socialstyrelsen.se) and the Swedish Association of Local Authorities and Regions (SALAR) run a national indicator-based benchmarking evaluation system for improving eldercare. In addition, local evaluation systems are set up to monitor and evaluate eldercare. Although evaluation systems are built to support public policy and governance in different ways (Hanberger, 2011; Hood, 1991; Pollitt and Boukaert, 2011; Kusek and Rist, 2004; Radin, 2006; Van Dooren et al, 2010), ultimately they are aimed to improve quality of care but the ways to achieve this differ.Researchers are concerned about the growing accountability pressure that professionals are subjected to (Ubels, 2015), and if external supervision is doing more harm than good (Beddoe, 2012; Furness, 2009). Disputes concern the value of hard evaluation systems (e.g. state supervision) and soft forms (e.g. benchmarking systems), for improving quality in eldercare, and that performance measures do not reflect care provided to concrete persons in concrete situations (Jerak-Zuiderent 2015). Braithwaite et al (2007) demonstrate that external inspection of nursing homes often fails because of “a variety of kinds of regulatory ritualism” (p.11). Inspections tend to prioritize paper-work, to fill in forms on outputs and other required information instead of 'pick important problems and fix them'.While policy makers generally convey high expectations to external evaluation professionals convey lower expectations or even resistance. This reflects a tension between political (hierarchical) accountability (Behn, 2001), which implies that performance of social services is monitored against politically and administratively predefined standards, and professional accountability, where good performance is based on trust in the professional agent being qualified to make situated judgment and improve practice (Evans, 2011; Evetts, 2009). While evaluation for political accountability conveys an inbuilt distrust in professionals, it relies on professionals to improve the performance of services (Van Dooren et al, 2010). Although evaluation systems are key components in eldercare governance (Clarkson & Challis, 2006; Johansson et al, 2015; Munro, 2004; Szebehely and Trydegård 2012) they have been scarcely researched, particularly how different systems operate in practice. If and how national and local evaluation systems, one by one and together, contribute to improve quality in eldercare is here further explored.This paper scrutinizes how two national evaluation systems and one local system operate in a Swedish municipality. National evaluation systems are the same for all communities whereas local evaluation systems vary (Lindgren, 2015). The three evaluation systems are all intended to support and maintain quality in eldercare. The focus is on the accountability and quality improvement functions, and the evaluation systems’ consequences for key-actors. A close look at one case, a Swedish municipality, allows for analyzing and comparing how the accountability and quality improvement function of three radically different evaluation system evolve and interplay at different local levels.
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| 8. |
- Hanberger, Anders, 1953-, et al.
(författare)
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Evaluation systems in local eldercare governance
- 2019
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Ingår i: Journal of Social Work. - : SAGE Publications. - 1468-0173 .- 1741-296X. ; 19:2, s. 233-252
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Tidskriftsartikel (refereegranskat)abstract
- This article explores how three evaluation systems in eldercare governance, two national and one local, operate and interact at the municipal, administrative, and service levels in a Swedish municipality. The case study focuses on the three systems' contributions to accountability and to improving eldercare quality. It is based on multiple sources, including 28 interviews with local key actors involved in local eldercare governance, and the results derive from a directed content analysis guided by four research questions. Findings The study demonstrates that the three evaluation systems support accountability and quality improvement in different ways and have different consequences for local actors. The systems create multiple accountability problems and have multiple constitutive effects, for example, creating different notions of what quality in eldercare means. The systems' contributions to improving eldercare quality differed: the net effect of the two national systems was negative, whereas the local system has helped improve eldercare quality without any identified negative effects so far. Applications The article broadens our theoretical understanding and knowledge of regulatory mechanisms in eldercare governance. It has significance for eldercare policy by finding that policymakers and service providers must be aware of and manage multiple evaluation systems and accountability problems. Its implication for eldercare practice is that local actors must build evaluation capacity to manage existing evaluation systems in order to improve their own practices.
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| 9. |
- Hanberger, Anders, 1953-, et al.
(författare)
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Hur kan granskning av äldreomsorg studeras?
- 2019. - 1
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Ingår i: Perspektiv på granskning inom offentlig sektor. - Malmö : Gleerups Utbildning AB. - 9789151100654 ; , s. 39-54
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Hanberger, Anders, et al.
(författare)
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Hur kan granskning av äldreomsorgen studeras?
- 2018
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Ingår i: Perspektiv på granskning inom offentlig sektor : Med äldreomsorgen som exempel. - Malmö : Gleerups Utbildning AB. - 9789151100654
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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