Fredriksson Mio, Eldh Ann Catrine, Vengberg Sofie, Dahlström Tobias, Halford Christina, Wallin Lars, Winblad Ulrika
Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
School of Health and Social Science, Dalarna University, 791 88, Falun, Sweden.
Implement Sci. 2014 Dec 28;9:189. doi: 10.1186/s13012-014-0189-6.
Through 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.
Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed.
The 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.
The 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.
通过一项国家政策协议，2012年至2016年期间将有超过1.67亿欧元投资于瑞典国家质量登记处（NQR）。该政策协议的意图之一是增加NQR数据在质量改进（QI）方面的应用。然而，关于医疗登记处等的使用如何带来质量改进的证据并不完整，且对非临床用途知之甚少。因此，目的是调查瑞典政治家和管理人员对基于国家登记数据进行质量改进的看法。
对四个郡议会的政治家和管理人员进行了访谈。采用了以实施研究综合框架（CFIR）为指导的定性内容分析。
政治家和管理人员对使用NQR数据进行质量改进的看法主要归为CFIR五个领域中的三个。在干预特征领域，数据可靠性和及时获取被认为不完全令人满意，这使得政治行政领导层难以启动、监测和支持及时的质量改进工作。不过，政治家和管理人员相信将NQR用作质量改进基础的想法。在内部环境领域，组织结构发展不足，无法利用NQR的优势，实施准备似乎也不足，原因有二。其一，在政治行政或临床层面，数据分析和质量改进的资源被认为不足。其二，描述了多层次领导参与的不足，且在政治家的角色和参与程度上缺乏共识。在外部环境领域，郡议会与国家NQR组织之间缺乏沟通与合作。
瑞典的经验表明，一个由政府支持、资金充足、管理良好且声誉良好的国家质量登记处系统若要用于质量改进，需要有利的地方政治行政条件；而根据地方政治家和管理人员的说法，这些条件尚未具备。
