Case-based information systems in Swedish health care. General aspects and experiences from the Stockholm County Council.

The paper gives a brief overview of some national case-based information systems in Swedish health care together with an application from the Stockholm County Council. A background section on the Swedish health care system is also included. Several case-based information systems have been developed within Swedish health care. They have different purposes and operate on different levels. General national registries include: discharge registry, medical birth registry, cancer registry and cause of death registry. They have been used mainly for research and planning of health services. Another type of national registries are related to specific patient groups. Such registries include information on results and complications of treatment. The initiative to these registries have come mainly from groups of consultants. The Stockholm County Council has replaced the traditionally global budgets of clinical departments with an activity based income. An evaluation project on health care utilization in five surgical specialties are presented. Preliminary results were: no division of in-patient care into multiple hospital stays and an increase in the number of discharges among the elderly. The Swedish health care system of today is characterized by organizational changes. Case-based information systems give the opportunity to study the developments of equity, quality and resource management in the new health care models. There is today an increased interest to use case-based information systems for quality assessment and continuous quality improvement. An increasing number of analyses are made at the local level. However, national case-based data are still very valuable to make regional comparisons possible and to produce relevant reference data in local applications.