Peterson Anette, Gudbjörnsdottir Soffia, Löfgren Ulla-Britt, Schiöler Linus, Bojestig Mats, Thor Johan, Andersson Gäre Boel
Healthcare Department, Region of Jönköping, Jönköping, Sweden (Ms Peterson and Dr Bojestig); The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden (Ms Peterson and Drs Thor and Andersson-Gäre); Center of Registers in Region Västra Götaland, Gothenburg, Sweden (Dr Gudbjörnsdottir and Ms Löfgren); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg, Sweden (Drs Gudbjörnsdottir); Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Drs Schiöler); and Futurum, Region of Jönköping, Jönköping, Sweden (Dr Andersson Gäre).
Qual Manag Health Care. 2015 Oct-Dec;24(4):212-21. doi: 10.1097/QMH.0000000000000068.
Since 1996, the Swedish National Diabetes Register (NDR) enabled health care providers to monitor their clinical performance over time and compare it with the national average. All health systems of Swedish county councils report data. By 2014, the NDR included data from 360 000 patients. Comparisons among county councils show significant variations in clinical outcomes and in adherence to evidence-based national guidelines. The purpose of this study was to evaluate whether and how a quality improvement collaborative could influence clinical practice and outcomes.
Twenty-three diabetes teams from all over Sweden, both primary care units and internal medicine departments, joined a quality improvement collaborative. The project was inspired by the Breakthrough Collaborative Model and lasted for 20 months. Evaluation data were collected from the teams' final reports and the NDR throughout the study period.
The teams reported improved patient outcomes significantly compared with the national average for systolic blood pressure and low-density lipoprotein levels. In contrast, glycated hemoglobin A1c levels deteriorated in the whole NDR population. Five themes of changes in practice were tested and implemented. Success factors included improved teamwork, with active use of register data, and testing new ideas and learning from others.
自1996年以来，瑞典国家糖尿病登记处（NDR）使医疗服务提供者能够长期监测其临床绩效，并与全国平均水平进行比较。瑞典各县议会的所有医疗系统都报告数据。到2014年，NDR包含了36万名患者的数据。各县议会之间的比较显示，临床结果和对基于证据的国家指南的遵守情况存在显著差异。本研究的目的是评估质量改进协作是否以及如何影响临床实践和结果。
来自瑞典各地的23个糖尿病团队，包括基层医疗单位和内科部门，加入了一个质量改进协作项目。该项目受到突破协作模式的启发，持续了20个月。在整个研究期间，从团队的最终报告和NDR收集评估数据。
与全国平均水平相比，这些团队报告的患者收缩压和低密度脂蛋白水平结果有显著改善。相比之下，整个NDR人群的糖化血红蛋白A1c水平恶化。测试并实施了实践中的五个变化主题。成功因素包括改善团队合作，积极使用登记数据，以及测试新想法并向他人学习。
