Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation ResearchReport as inadecuate




Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research - Download this document for free, or read online. Document in PDF available to download.

Implementation Science

, 9:189

First Online: 28 December 2014Received: 16 May 2014Accepted: 04 December 2014DOI: 10.1186-s13012-014-0189-6

Cite this article as: Fredriksson, M., Eldh, A.C., Vengberg, S. et al. Implementation Sci 2014 9: 189. doi:10.1186-s13012-014-0189-6

Abstract

BackgroundThrough a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries NQRs between 2012 and 2016. One of the policy agreement’s intentions is to increase the use of NQR data for quality improvement QI. However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data.

MethodsPoliticians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research CFIR was performed.

ResultsThe politicians’ and administrators’ perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians’ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations.

ConclusionsThe Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

KeywordsQuality registry Clinical database Clinical registry Implementation Quality improvement Consolidated Framework for Implementation Research AbbreviationsCFIRConsolidated Framework for Implementation Research

EPRElectronic patient record

NQRNational Quality Registry

OECDOrganization for Economic Cooperation and Development

QIQuality improvement

SALARSwedish Association of Local Authorities and Regions

Electronic supplementary materialThe online version of this article doi:10.1186-s13012-014-0189-6 contains supplementary material, which is available to authorized users.

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Author: Mio Fredriksson - Ann Catrine Eldh - Sofie Vengberg - Tobias Dahlström - Christina Halford - Lars Wallin - Ulrika Winblad

Source: https://link.springer.com/







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