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Dempsey K, Ferguson C, Walczak A, Middleton S, Levi C, Morton RL, Boydell K, Campbell M, Cass A, Duff J, Elliott C, Geelhoed G, Jones A, Keech W, Leone V, Liew D, Linedale E, Mackinolty C, McFayden L, Norris S, Skouteris H, Story D, Tucker R, Wakerman J, Wallis L, Waterhouse T, Wiggers J. Which strategies support the effective use of clinical practice guidelines and clinical quality registry data to inform health service delivery? A systematic review. Syst Rev 2022; 11:237. [PMID: 36352475 PMCID: PMC9644489 DOI: 10.1186/s13643-022-02104-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Empirical evidence suggests data and insights from the clinical practice guidelines and clinical quality registries are not being fully utilised, leaving health service managers, clinicians and providers without clear guidance on how best to improve healthcare delivery. This lack of uptake of existing research knowledge represents low value to the healthcare system and needs to change. METHODS Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews) were systematically searched. Included studies were published between 2000 and 2020 reporting on the attributes, evidence usage and impact of clinical practice guidelines and clinical quality registries on health service delivery. RESULTS Twenty-six articles including one randomised controlled trial, eight before-and-after studies, eight case studies/reviews, five surveys and four interview studies, covering a wide range of medical conditions and conducted in the USA, Australia and Europe, were identified. Five complementary strategies were derived to maximise the likelihood of best practice health service delivery: (1) feedback and transparency, (2) intervention sustainability, (3) clinical practice guideline adherence, (4) productive partnerships and (5) whole-of-team approach. CONCLUSION These five strategies, used in context-relevant combinations, are most likely to support the application of existing high-quality data, adding value to health service delivery. The review highlighted the limitations of study design in opportunistic registry studies that do not produce clear, usable evidence to guide changes to health service implementation practices. Recommendations include exploration of innovative methodologies, improved coordination of national registries and the use of incentives to encourage guideline adherence and wider dissemination of strategies used by successful registries.
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Affiliation(s)
- Kathy Dempsey
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | | | - Adam Walczak
- Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), University of NSW, Kensington, Australia
| | - Sandy Middleton
- Nursing Research Unit, Australian Catholic University, Sydney, Australia
| | - Christopher Levi
- Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), University of NSW, Kensington, Australia
| | - Rachael L Morton
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
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Public health nurses’ views on quality measures: A cross-sectional study. Collegian 2022. [DOI: 10.1016/j.colegn.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kilander H, Weinryb M, Vikström M, Petersson K, Larsson EC. Developing contraceptive services for immigrant women postpartum - a case study of a quality improvement collaborative in Sweden. BMC Health Serv Res 2022; 22:556. [PMID: 35473622 PMCID: PMC9040323 DOI: 10.1186/s12913-022-07965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 04/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Immigrant women use less effective contraceptive methods and have a higher risk of unintended pregnancies. Maternal health care services offer a central opportunity to strengthen contraceptive services, especially among immigrants. This study aimed to evaluate a Quality Improvement Collaborative QIC. Its objective was to improve contraceptive services for immigrant women postpartum, through health care professionals’ (HCPs) counselling and a more effective choice of contraceptive methods. Methods The pilot study was designed as an organisational case study including both qualitative and quantitative data collection and analysis. Midwives at three maternal health clinics (MHCs) in Stockholm, Sweden participated in a QIC during 2018–2019. In addition, two recently pregnant women and a couple contributed user feedback. Data on women’s choice of contraceptive method at the postpartum visit were registered in the Swedish Pregnancy Register over 1 year. Results The participating midwives decided that increasing the proportion of immigrant women choosing a more effective contraceptive method postpartum would be the goal of the QIC. Evidence-based changes in contraceptive services, supported by user feedback, were tested in clinical practice during three action periods. During the QIC, the proportion of women choosing a more effective contraceptive method postpartum increased at an early stage of the QIC. Among immigrant women, the choice of a more effective contraception increased from 30 to 47% during the study period. Midwives reported that their counselling skills had developed due to participation in the QIC, and they found using a register beneficial for evaluating women’s choice of contraceptive methods. Conclusions The QIC, supported by a register and user feedback, helped midwives to improve their contraceptive services during the pregnancy and postpartum periods. Immigrant women’s choice of a more effective contraceptive method postpartum increased during the QIC. This implies that a QIC could increase the choice of a more effective contraception of postpartum contraception among immigrants.
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Affiliation(s)
- Helena Kilander
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare Jönköping University, Jönköping, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences and Department of Obstetrics and Gynaecology, Region Jönköping County, Linköping University, Linköping, Sweden
| | - Maja Weinryb
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Malin Vikström
- Maternal Healthcare Unit, Stockholm South General Hospital, The Health and Medical Care Administration, Region Stockholm County, Stockholm, Sweden
| | - Kerstin Petersson
- Maternal Healthcare Unit, Stockholm South General Hospital, The Health and Medical Care Administration, Region Stockholm County, Stockholm, Sweden.,Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden. .,Department of Global Public Health, Karolinska Institutet, Widerströmska huset, floor 3, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Using aggregated data from Swedish national quality registries as tools to describe health conditions of older adults with complex needs. Aging Clin Exp Res 2021; 33:1297-1306. [PMID: 32535857 PMCID: PMC8081709 DOI: 10.1007/s40520-020-01629-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/06/2020] [Indexed: 01/09/2023]
Abstract
Background Combining National Quality Registries (NQRs) with existing National Health Registries (NHRs) might make it possible to get a wider picture of older adults health situation. The aim was to examine the feasibility of aggregating data across different NQRs and existing NHRs to explore the possibility to investigate trajectories and patterns of disease and care, specifically for the most ill older adults. Method A Swedish twin population (N = 44,816) was linked to nine NQRs and four NHRs. A descriptive mixed-method study was performed. A manifest content analysis identified which health parameters were collected from each NQR. Factor analysis identified patterns in representation across NQRs. Two case studies illustrated individual trajectories of care by using NQRs and NHRs. Results About 36% of the population was registered in one or more NQRs. NQRs included 1849 variables that were sorted into 13 categories with extensive overlap across the NQRs. Health and function variables were identified, but few social or cognitive variables. Even though most individuals demonstrated unique patterns of multi-morbidities, factor analysis identified three clusters of representation in the NQRs with sufficient sample sizes for future investigations. The two cases illustrated the possibility of following patterns of disease and trajectories of care. Conclusions NQRs seem to be a significant source for collecting data about a population that may be underrepresented in most research on aging because of their age and poor health. However, NQRs are primarily disease related, and further development of the registries to maximize coverage and utility is needed. Electronic supplementary material The online version of this article (10.1007/s40520-020-01629-6) contains supplementary material, which is available to authorized users.
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Norman AC, Elg M, Nordin A, Gäre BA, Algurén B. The role of professional logics in quality register use: a realist evaluation. BMC Health Serv Res 2020; 20:107. [PMID: 32046710 PMCID: PMC7014753 DOI: 10.1186/s12913-020-4944-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/28/2020] [Indexed: 12/03/2022] Open
Abstract
Background Clinical practice improvements based on quality-register data are influenced by multiple factors. Although there is agreement that information from quality registers is valuable for quality improvement, practical ways of organising register use have been notoriously difficult to realise. The present study sought to investigate the mechanisms that lead various clinicians to use quality registers for improvement. Methods This research involves studying individuals’ decisions in response to a Swedish programme focusing on increasing the use of quality registers. Through a case study, we focused on heart failure care and its corresponding register: the Swedish Heart Failure Register. The empirical data consisted of a purposive sample collected longitudinally by qualitative methods between 2013 and 2015. In total, 18 semi-structured interviews were carried out. We used realist evaluation to identify contexts, mechanisms, and outcomes. Results We identified four contexts – registration, use of output data, governance, and improvement projects – that provide conditions for the initiation of specific mechanisms. Given a professional theoretical perspective, we further showed that mechanisms are based on the logics of either organisational improvement or clinical practice. The two logics offer insights into the ways in which clinicians choose to embrace or reject certain registers’ initiatives. Conclusions We identified a strong path dependence, as registers have historically been tightly linked to the medical profession’s competence. Few new initiatives in the studied programme reach the clinical context. We explain this through the lack of an organisational improvement logic and its corresponding mechanisms in the context of the medical profession. Implementation programmes must understand the logic of clinical practice; that is, be integrated with the ways in which work is carried out in everyday practice. Programmes need to be better at helping core health professionals to reach the highest standards of patient care.
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Affiliation(s)
- Ann-Charlott Norman
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11, Jönköping, Sweden.
| | - Mattias Elg
- Department of Management and Engineering, HELIX Competence Centre, Linköping University, Linköping, Sweden
| | - Annika Nordin
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11, Jönköping, Sweden
| | - Boel Andersson Gäre
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11, Jönköping, Sweden.,Futurum, Academy for Health and Care Region Jönköping County, Ryhov County Hospital, Jönköping, Sweden
| | - Beatrix Algurén
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11, Jönköping, Sweden.,Department of Food and Nutrition, and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
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Algurén B, Nordin A, Andersson-Gäre B, Peterson A. In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data-possible factors contributing to sustained improvement in outcomes beyond the project time. Implement Sci 2019; 14:74. [PMID: 31337394 PMCID: PMC6647054 DOI: 10.1186/s13012-019-0926-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years. METHODS Final reports of two QICs-one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics. RESULTS The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013. CONCLUSIONS Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular.
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Affiliation(s)
- Beatrix Algurén
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Faculty of Education, Box 300, 405 30, Gothenburg, Sweden. .,School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Annika Nordin
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Boel Andersson-Gäre
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.,Futurum, Region Jönköping County, Jönköping, Sweden
| | - Anette Peterson
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.,Futurum, Region Jönköping County, Jönköping, Sweden
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Silverio A, Cavallo P, De Rosa R, Galasso G. Big Health Data and Cardiovascular Diseases: A Challenge for Research, an Opportunity for Clinical Care. Front Med (Lausanne) 2019; 6:36. [PMID: 30873409 PMCID: PMC6401640 DOI: 10.3389/fmed.2019.00036] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/05/2019] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease (CVD) accounts for the majority of death and hospitalization, health care expenditures and loss of productivity in developed country. CVD research, thus, plays a key role for improving patients' outcomes as well as for the sustainability of health systems. The increasing costs and complexity of modern medicine along with the fragmentation in healthcare organizations interfere with improving quality care and represent a missed opportunity for research. The advancement in diagnosis, therapy and prognostic evaluation of patients with CVD, indeed, is frustrated by limited data access to selected small patient populations, not standardized nor computable definition of disease and lack of approved relevant patient-centered outcomes. These critical issues results in a deep mismatch between randomized controlled trials and real-world setting, heterogeneity in treatment response and wide inter-individual variation in prognosis. Big data approach combines millions of people's electronic health records (EHR) from different resources and provides a new methodology expanding data collection in three direction: high volume, wide variety and extreme acquisition speed. Large population studies based on EHR holds much promise due to low costs, diminished study participant burden, and reduced selection bias, thus offering an alternative to traditional ascertainment through biomedical screening and tracing processes. By merging and harmonizing large data sets, the researchers aspire to build algorithms that allow targeted and personalized CVD treatments. In current paper, we provide a critical review of big health data for cardiovascular research, focusing on the opportunities of this largely free data analytics and the challenges in its realization.
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Affiliation(s)
- Angelo Silverio
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Pierpaolo Cavallo
- Department of Physics "E.R. Caianiello", University of Salerno, Salerno, Italy
| | - Roberta De Rosa
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Gennaro Galasso
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
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