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Ahern S. Clinical registries: Not yet perfect, but essential for a high-functioning health system. Respirology 2023; 28:983-985. [PMID: 37495234 DOI: 10.1111/resp.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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2
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Clinical registries data quality attributes to support registry-based randomised controlled trials: A scoping review. Contemp Clin Trials 2022; 119:106843. [DOI: 10.1016/j.cct.2022.106843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 11/19/2022]
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3
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Hooshafza S, Mc Quaid L, Stephens G, Flynn R, O’Connor L. Development of a framework to assess the quality of data sources in healthcare settings. J Am Med Inform Assoc 2022; 29:944-952. [PMID: 35190833 PMCID: PMC9006677 DOI: 10.1093/jamia/ocac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/21/2021] [Accepted: 02/07/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of this study was to develop a framework to assess the quality of healthcare data sources. MATERIALS AND METHODS First, a systematic review was performed and a thematic analysis of included literature conducted to identify items relating to the quality of healthcare data sources. Second, expert advisory group meetings were held to explore experts' perception of the results of the review and identify gaps in the findings. Third, a framework was developed based on the findings. RESULTS Synthesis of the review results and expert advisory group meetings resulted in 8 parent themes and 22 subthemes. The parent themes were: Governance, leadership, and management; Data; Trust; Context; Monitoring; Use of information; Standardization; Learning and training. The 22 subthemes were: governance, finance, organization, characteristics, time, data management, data quality, ethics, access, security, quality improvement, monitoring and feedback, dissemination, analysis, research, standards, linkage, infrastructure, documentation, definitions and classification, learning, and training. DISCUSSION The herein presented framework was developed using a robust methodology which included reviewing literature and extracting data source quality items, filtering, and matching items, developing a list of themes, and revising them based on expert opinion. To the best of our knowledge, this study is the first to apply a systematic approach to identify aspects related to the quality of healthcare data sources. CONCLUSIONS The framework, can assist those using healthcare data sources to identify and assess the quality of a data source and inform whether the data sources used are fit for their intended use.
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Affiliation(s)
- Sepideh Hooshafza
- Health Information and Quality Authority (HIQA), Cork, Ireland,The SFI ADAPT Research Centre for AI-Driven Digital Content Technology, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Louise Mc Quaid
- Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Gaye Stephens
- The SFI ADAPT Research Centre for AI-Driven Digital Content Technology, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Rachel Flynn
- Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Laura O’Connor
- Corresponding Author: Laura O’Connor, BSc, PhD, Health Information and Quality Authority (HIQA), Unit 1301, City Gate, Mahon, Cork T12 Y2XT, Ireland;
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Brown WA, Ahern S, MacCormick AD, Reilly JR, Smith JA, Watters DA. Clinical quality registries: urgent reform is required to enable best practice and best care. ANZ J Surg 2022; 92:23-26. [PMID: 35040551 DOI: 10.1111/ans.17438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
Clinical quality registries (CQRs) systematically collect data on pre-agreed markers of quality of care for a given procedure, that can be reliably and reproducibly defined and collected across multiple sites. Data is then risk adjusted, and comparisons may be used to benchmark performance. These data then inform quality improvement initiatives. CQRs require an overarching independent governance structure and surety of funding. CQRs rely upon whole of population enrolment to minimize the risk of selection bias, and often rely on the secondary use of sensitive health information, meaning that the processes for ethical review and consent to participation are different to clinical trials. Despite several local examples of CQR improving practice in Australia and Aotearoa New Zealand, providing substantial cost-benefit to the community, there remain significant barriers to CQR implementation and functions. These include the difficulty of accurate data capture, lack of a fit for purpose ethical review system, the constraints of existing Qualified Privilege legislations and the need for protected funding. Whilst the Australian Government has released a 10-year strategy for CQR reform, and the Aotearoa New Zealand Government has included registries in the planned Health New Zealand reforms for the public sector, we believe more urgent implementation of strategies to overcome these barriers is needed if CQRs are to have the impact on quality of care our Communities deserve.
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Affiliation(s)
- Wendy A Brown
- Department of Surgery, Central Clinical School, Alfred Health, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Jennifer R Reilly
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Victoria, Australia.,Department of Anaesthesia and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - David A Watters
- Department of Surgery, Deakin University, Barwon Health, Geelong, Victoria, Australia
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5
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Haig Y, Feiring E. Stakeholder views of the development of a clinical quality registry for interventional radiology: a qualitative study. BMC Health Serv Res 2022; 22:44. [PMID: 34998395 PMCID: PMC8742914 DOI: 10.1186/s12913-021-07423-y] [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: 06/28/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Clinical quality registries (CQRs) can likely improve quality in healthcare and research. However, studies indicate that effective use of CQRs is hindered by lack of engagement and interest among stakeholders, as well as factors related to organisational context, registry design and data quality. To fulfil the potential of CQRs, more knowledge on stakeholders’ perceptions of the factors that will facilitate or hamper the development of CQRs is essential to the more appropriate targeting of registry implementation and the subsequent use of the data. The primary aim of this study was to examine factors that can potentially affect the development of a national CQR for interventional radiology in Norway from the perspective of stakeholders. Furthermore, we wanted to identify the intervention functions likely to enable CQR development. Only one such registry, located in Sweden, has been established. To provide a broader context for the Norwegian study, we also sought to investigate experiences with the development of this registry. Methods A qualitative study of ten Norwegian radiologists and radiographers using focus groups was conducted, and an in-depth interview with the initiator of the Swedish registry was carried out. Questions were based on the Capability, Opportunity and Motivation for Behaviour Model and the Theoretical Domains Framework. The participants’ responses were categorised into predefined themes using a deductive process of thematic analysis. Results Knowledge of the rationale used in establishing a CQR, beliefs about the beneficial consequences of a registry for quality improvement and research and an opportunity to learn from a well-developed registry were perceived by the participants as factors facilitating CQR development. The study further identified a range of development barriers related to environmental and resource factors (e.g., a lack of organisational support, time) and individuallevel factors (e.g., role boundaries, resistance to change), as well as several intervention functions likely to be appropriate in targeting these barriers. Conclusion This study provides a deeper understanding of factors that may be involved in the behaviour of stakeholders regarding the development of a CQR. The findings may assist in designing, implementing and evaluating a methodologically rigorous CQR intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07423-y.
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Affiliation(s)
- Ylva Haig
- Department of Radiology, Oslo University Hospital- Ullevål, PO Box 4950 Nydalen, 0424, Oslo, Norway.
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, PO Box 1089 Blindern, 0317, Oslo, Norway
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Carrwik C, Olerud C, Robinson Y. Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study. BMJ Open 2021; 11:e049198. [PMID: 34725074 PMCID: PMC8562515 DOI: 10.1136/bmjopen-2021-049198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate survival after surgery and indications for surgery due to spinal metastatic disease. DESIGN A retrospective longitudinal multiregistry nationwide cohort study. SETTING 19 public hospitals in Sweden with spine surgery service, where 6 university hospitals account for over 90% of the cases. PARTICIPANTS 1820 patients 18 years or older undergoing surgery due to spinal metastatic disease 2006-2018 and registered in Swespine, the Swedish national spine surgery registry. INTERVENTIONS Decompressive and/or stabilising spine surgery due to spinal metastatic disease. PRIMARY OUTCOME Survival (median and mean) after surgery. SECONDARY OUTCOMES Indications for surgery, types of surgery and causes of death. RESULTS The median estimated survival after surgery was 6.2 months (95% CI: 5.6 to 6.8) and the mean estimated survival time was 12.2 months (95% CI: 11.4 to 13.1). Neurologic deficit was the most common indication for surgery and posterior stabilisation was performed in 70.5% of the cases. A neoplasm was stated as the main cause of death for 97% of the patients. CONCLUSION Both median and mean survival times were well above the generally accepted thresholds for surgical treatment for spinal metastases, suggesting that patient selection for surgical treatment on a national level is adequate. Further research on quality of life after surgery and prognostication is needed.
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Affiliation(s)
- Christian Carrwik
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Yohan Robinson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Research and Development, Armed Forces Centre for Defence Medicine, Vastra Frolunda, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
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Gawthorne J, Fasugba O, Levi C, Mcinnes E, Ferguson C, Mcneil JJ, Cadilhac DA, Everett B, Fernandez R, Fry M, Goldsmith H, Hickman L, Jackson D, Maguire J, Murray E, Perry L, Middleton S. Are clinicians using routinely collected data to drive practice improvement? A cross-sectional survey. Int J Qual Health Care 2021; 33:6382278. [PMID: 34613386 DOI: 10.1093/intqhc/mzab141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/13/2021] [Accepted: 10/06/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Clinical registry participation is a measure of healthcare quality. Limited knowledge exists on Australian hospitals' participation in clinical registries and whether this registry data informs quality improvement initiatives. OBJECTIVE To identify participation in clinical registries, determine if registry data inform quality improvement initiatives, and identify registry participation enablers and clinicians' educational needs to improve use of registry data to drive practice change. METHODS A self-administered survey was distributed to staff coordinating registries in seven hospitals in New South Wales, Australia. Eligible registries were international-, national- and state-based clinical, condition-/disease-specific and device/product registries. RESULTS Response rate was 70% (97/139). Sixty-two (64%) respondents contributed data to 46 eligible registries. Registry reports were most often received by nurses (61%) and infrequently by hospital executives (8.4%). Less than half used registry data 'always' or 'often' to influence practice improvement (48%) and care pathways (49%). Protected time for data collection (87%) and benchmarking (79%) were 'very likely' or 'likely' to promote continued participation. Over half 'strongly agreed' or 'agreed' that clinical practice improvement training (79%) and evidence-practice gap identification (77%) would optimize use of registry data. CONCLUSIONS Registry data are generally only visible to local speciality units and not routinely used to inform quality improvement. Centralized on-going registry funding, accessible and transparent integrated information systems combined with data informed improvement science education could be first steps to promote quality data-driven clinical improvement initiatives.
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Affiliation(s)
- Julie Gawthorne
- St Vincent's Hospital Sydney, Victoria Street, Darlinghurst, NSW 2010, Australia.,Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5 deLacy Building, Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Oyebola Fasugba
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5 deLacy Building, Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Chris Levi
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Elizabeth Mcinnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5 deLacy Building, Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District, Western Sydney University, Marcel Crescent, Blacktown, NSW 2148, Australia
| | - John J Mcneil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, School of Clinical Sciences, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, VIC 3084, Australia
| | - Bronwyn Everett
- School of Nursing and Midwifery, Western Sydney University, Building EB.LG Room 81, Parramatta South Campus, Victoria Rd, Rydalmere, NSW 2116, Australia
| | - Ritin Fernandez
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
| | - Margaret Fry
- Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW 2065, Australia.,School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - Helen Goldsmith
- Centre for Applied Nursing Research, South Western Sydney Local Health District, Ingham Institute Level 3, 1 Campbell Street, Liverpool, NSW 2170, Australia
| | - Louise Hickman
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - Deborah Jackson
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - Jane Maguire
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - Edel Murray
- St Vincent's Health Australia, Level 22, 100 William Street, Woolloomooloo, NSW 2010, Australia
| | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia.,Prince of Wales Hospital, South East Sydney Local Health District, 320-346 Barker St, Randwick, NSW 2031, Australia
| | - Sandy Middleton
- St Vincent's Hospital Sydney, Victoria Street, Darlinghurst, NSW 2010, Australia.,Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5 deLacy Building, Victoria Street, Darlinghurst, NSW 2010, Australia
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Scheibner J, Sleigh J, Ienca M, Vayena E. Benefits, challenges, and contributors to success for national eHealth systems implementation: a scoping review. J Am Med Inform Assoc 2021; 28:2039-2049. [PMID: 34151990 DOI: 10.1093/jamia/ocab096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Our scoping review aims to assess what legal, ethical, and socio-technical factors contribute to or inhibit the success of national eHealth system implementations. In addition, our review seeks to describe the characteristics and benefits of eHealth systems. MATERIALS AND METHODS We conducted a scoping review of literature published in English between January 2000 and 2020 using a keyword search on 5 databases: PubMed, Scopus, Web of Science, IEEEXplore, and ProQuest. After removal of duplicates, abstract screening, and full-text filtering, 86 articles were included from 8276 search results. RESULTS We identified 17 stakeholder groups, 6 eHealth Systems areas, and 15 types of legal regimes and standards. In-depth textual analysis revealed challenges mainly in implementation, followed by ethico-legal and data-related aspects. Key factors influencing success include promoting trust of the system, ensuring wider acceptance among users, reconciling the system with legal requirements, and ensuring an adaptable technical platform. DISCUSSION Results revealed support for decentralized implementations because they carry less implementation and engagement challenges than centralized ones. Simultaneously, due to decentralized systems' interoperability issues, federated implementations (with a set of national standards) might be preferable. CONCLUSION This study identifies the primary socio-technical, legal, and ethical factors that challenge and contribute to the success of eHealth system implementations. This study also describes the complexities and characteristics of existing eHealth implementation programs, and suggests guidance for resolving the identified challenges.
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Affiliation(s)
- James Scheibner
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland.,College of Business, Government and Law, Flinders University, Adelaide, Australia
| | - Joanna Sleigh
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
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Algurén B, Jernberg T, Vasko P, Selb M, Coenen M. Content comparison and person-centeredness of standards for quality improvement in cardiovascular health care. PLoS One 2021; 16:e0244874. [PMID: 33411709 PMCID: PMC7790275 DOI: 10.1371/journal.pone.0244874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Quality standards are important for improving health care by providing compelling evidence for best practice. High quality person-centered health care requires information on patients' experience of disease and of functioning in daily life. OBJECTIVE To analyze and compare the content of five Swedish National Quality Registries (NQRs) and two standard sets of the International Consortium of Health Outcomes Measurement (ICHOM) related to cardiovascular diseases. MATERIALS AND METHODS An analysis of 2588 variables (= data items) of five NQRs-the Swedish Registry of Congenital Heart Disease, Swedish Cardiac Arrest Registry, Swedish Catheter Ablation Registry, Swedish Heart Failure Registry, SWEDEHEART (including four sub-registries) and two ICHOM standard sets-the Heart Failure Standard Set and the Coronary Artery Disease Standard Set. According to the name and definition of each variable, the variables were mapped to Donabedian's quality criteria, whereby identifying whether they capture health care processes or structures or patients' health outcomes. Health outcomes were further analyzed whether they were clinician- or patient-reported and whether they capture patients' physiological functions, anatomical structures or activities and participation. RESULTS In total, 606 variables addressed process quality criteria (31%), 58 structure quality criteria (3%) and 760 outcome quality criteria (38%). Of the outcomes reported, 85% were reported by clinicians and 15% by patients. Outcome variables addressed mainly 'Body functions' (n = 392, 55%) or diseases (n = 209, 29%). Two percent of all documented data captured patients' lived experience of disease and their daily activities and participation (n = 51, 3% of all variables). CONCLUSIONS Quality standards in the cardiovascular field focus predominately on processes (e.g. treatment) and on body functions-related outcomes. Less attention is given to patients' lived experience of disease and their daily activities and participation. The results can serve as a starting-point for harmonizing data and developing a common person-centered quality indicator set.
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Affiliation(s)
- Beatrix Algurén
- Faculty of Education, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
- The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Peter Vasko
- Department of Internal Medicine, Central Hospital, Växjö, Sweden
| | - Melissa Selb
- ICF Research Branch, a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications (at DIMDI), Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Michaela Coenen
- ICF Research Branch, a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications (at DIMDI), Nottwil, Switzerland
- Department of Medical Information Processing, Biometry and Epidemiology—IBE, Chair of Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- Pettenkofer School of Public Health (PSPH), Munich, Germany
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Westerlund A, Sparring V, Hasson H, Weinehall L, Nyström ME. Working with national quality registries in older people care: A qualitative study of perceived impact on assistant nurses' work situation. Nurs Open 2021; 8:130-139. [PMID: 33318820 PMCID: PMC7729790 DOI: 10.1002/nop2.611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
Aim The aim was to investigate assistant nurses' perceptions of how working with national quality registries affected their work situation in care of older people. Design Qualitative interview study. Methods Sixteen semi-structured interviews were conducted at four special housing units in Sweden, and a conventional content analysis, with elements of thematic analysis, was applied. Results The introduction of national quality registries contributed to role clarifications and the development of new formal work procedures in terms of documentation and arenas and routines for communication. The increased systematics and effectiveness gained from these changes had a perceived positive effect on the work situation, workload, work satisfaction, staff interactions and learning and reflection.
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Affiliation(s)
- Anna Westerlund
- Department of Epidemiology and Global healthUmeå UniversityUmeåSweden
| | - Vibeke Sparring
- Department of LearningInformatics, Management and EthicsMedical Management CentreKarolinska InstitutetStockholmSweden
| | - Henna Hasson
- Department of LearningInformatics, Management and EthicsMedical Management CentreKarolinska InstitutetStockholmSweden
- Centre for Epidemiology and Community Medicine (CES)Stockholm County CouncilStockholmSweden
| | - Lars Weinehall
- Department of Epidemiology and Global healthUmeå UniversityUmeåSweden
| | - Monica E. Nyström
- Department of Epidemiology and Global healthUmeå UniversityUmeåSweden
- Department of LearningInformatics, Management and EthicsMedical Management CentreKarolinska InstitutetStockholmSweden
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11
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Ahern S, Evans S, Hopper I, Zalcberg J. Towards a strategy for clinical quality registries in Australia. AUST HEALTH REV 2020; 43:284-287. [PMID: 29415798 DOI: 10.1071/ah17201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 12/13/2017] [Indexed: 11/23/2022]
Abstract
The healthcare value of Australian clinical quality registries (CQRs) has recently been highlighted by the Australian Commission of Safety and Quality in Health Care (ACSQHC) as being similar to the benefits of CQRs reported internationally. However, the development of CQRs in Australia is currently limited by a lack of coordination and strategic planning, leading to governance and funding processes that are varied and non-sustainable. Despite this, Australia has achieved recognised success with exemplar clinical registries where funding has been sustained at least partly by public funds. To this end, Australia can learn from international CQR governance and funding models to support CQR sustainability, most notably those from European and Scandinavian countries. Further, following the release of the ACSQHC's prioritised domains for CQRs and anticipated funding from the Medical Research Future Fund, the ACSQHC is well positioned to lead a national strategic approach for clinical registries. Together with medical leadership and engagement, operational and data management support from the jurisdictions and financial support from both the public and private sectors, a prioritised and coordinated approach may soon become a reality.
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Affiliation(s)
- Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Vic. 3004, Australia.
| | - Sue Evans
- School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Vic. 3004, Australia.
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Vic. 3004, Australia.
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Vic. 3004, Australia.
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12
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Böling S, Berlin JM, Berglund H, Öhlén J. No ordinary consultation - a qualitative inquiry of hospital palliative care consultation services. J Health Organ Manag 2020; ahead-of-print. [PMID: 32744038 DOI: 10.1108/jhom-04-2020-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Considering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards. DESIGN/METHODOLOGY/APPROACH Focus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis. FINDINGS Variations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards. ORIGINALITY/VALUE A lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.
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Affiliation(s)
- Susanna Böling
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan M Berlin
- Department of Social and Behavioural Studies, University West, Trollhättan, Sweden
| | - Helene Berglund
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
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13
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Didier R, Gouysse M, Eltchaninoff H, Le Breton H, Commeau P, Cayla G, Glatt N, Glatt B, Gabbas M, Tuppin P, Liepchitz L, Boussac M, Iung B, Gilard M. Successful linkage of French large-scale national registry populations to national reimbursement data: Improved data completeness and minimized loss to follow-up. Arch Cardiovasc Dis 2020; 113:534-541. [DOI: 10.1016/j.acvd.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/11/2020] [Accepted: 04/08/2020] [Indexed: 10/23/2022]
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Kane RL, Chung KC. Establishing a National Registry for Hand Surgery. J Hand Surg Am 2020; 45:57-61. [PMID: 31780338 DOI: 10.1016/j.jhsa.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/23/2019] [Indexed: 02/02/2023]
Abstract
Hand surgery leadership in the United States must identify and define what quality care means for its patients. To achieve this, the surgical team needs a standardized framework to track and improve quality. This is necessary not only in our value-based health care system but also in light of considerable provider variation in the management of common hand conditions and the ongoing need for evidence-based guidelines to inform decision-making. Building a national registry for the field of hand surgery could be the solution and warrants serious consideration. A registry designed by hand surgery experts can collect data on process and outcome measures that are meaningful and specific to patients with hand conditions. These data inform the surgical team regarding where to focus their efforts for improvement. Existing methods of quality measurement are not compatible with hand surgery, a field with an ambulatory setting and rare incidence of mortality. Patient-reported outcomes, such as health-related quality of life, represent a more useful measure of quality for hand surgery and are just one example of the type of data that could be tracked using a national registry. An investment in a large-scale registry could seamlessly integrate patient preferences, values, and expectations into clinical practice so that desired outcomes can be delivered consistently across the nation.
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Affiliation(s)
- Robert L Kane
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
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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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Algurén B, Andersson-Gäre B, Thor J, Andersson AC. Quality indicators and their regular use in clinical practice: results from a survey among users of two cardiovascular National Registries in Sweden. Int J Qual Health Care 2019; 30:786-792. [PMID: 29762660 DOI: 10.1093/intqhc/mzy107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/24/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To examine the regular use of quality indicators from Swedish cardiovascular National Quality Registries (NQRs) by clinical staff; particularly differences in use between the two NQRs and between nurses and physicians. Design Cross-sectional online survey study. Setting Two Swedish cardiovascular NQRs: (a) Swedish Heart Failure Registry and (b) Swedeheart. Participants Clinicians (n =185; 70% nurses, 26% physicians) via the NQRs' email networks. Main Outcome Measures Frequency of NQR use for (a) producing healthcare activity statistics; (b) comparing results between similar departments; (c) sharing results with colleagues; (d) identifying areas for quality improvement (QI); (e) surveilling the impact of QI efforts; (f) monitoring effects of implementation of new treatment methods; (g) doing research and (h) educating and informing healthcare professionals and patients. Results Median use of NQRs was 10 times a year (25th and 75th percentiles range: 3-23 times/year). Quality indicators from the NQRs were used mainly for producing healthcare activity statistics. Median use of Swedeheart was six times greater than Swedish Heart Failure Registry (SwedeHF; P < 0.000). Physicians used the NQRs more than twice as often as nurses (18 vs. 7.5 times/year; P < 0.000) and perceived NQR work more often as meaningful. Around twice as many Swedeheart users had the role to participate in data analysis and in QI efforts compared to SwedeHF users. Conclusions Most respondents used quality indicators from the two cardiovascular NQRs infrequently (<3 times/year). The results indicate that linking registration of quality indicators to using them for QI activities increases their routine use and makes them meaningful tools for professionals.
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Affiliation(s)
- Beatrix Algurén
- Jönköping University, School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden.,Faculty of Education, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Boel Andersson-Gäre
- Jönköping University, School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden.,Region Jönköping County, Futurum, Jönköping, Sweden
| | - Johan Thor
- Jönköping University, School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Ann-Christine Andersson
- Jönköping University, School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
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Klinge B, Lundström M, Rosén M, Bertl K, Klinge A, Stavropoulos A. Dental Implant Quality Register-A possible tool to further improve implant treatment and outcome. Clin Oral Implants Res 2019; 29 Suppl 18:145-151. [PMID: 30306699 DOI: 10.1111/clr.13268] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/05/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
The Board of EAO (European Association for Osseointegration) has discussed an initiative to explore the conditions to establish a Dental Implant Register. It was suggested to bring this issue to the EAO Consensus Conference 2018 for a discussion and to possibly propose relevant and manageable parameters. This article presents some select examples from quality registers in the medical field. Based on the experience of established registers, essentially in the medical field, factors considered to be of importance, if and when establishing a Dental Implant Register are introduced and discussed.
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Affiliation(s)
- Björn Klinge
- Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden.,Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Måns Rosén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Bertl
- Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden.,Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Anna Klinge
- Department of Oral & Maxillofacial Surgery, Faculty of Odontology, Malmo University, Malmo, Sweden
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden
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Subbe CP, Øvretveit J, Quinn N, Wyatt JC. DIGITAL TECHNOLOGY: Opportunities and barriers for usage of personal health records in hospital - report from a -workshop of the Health Informatics Unit at the Royal -College of Physicians. Future Healthc J 2019; 6:52-56. [PMID: 31098587 PMCID: PMC6520086 DOI: 10.7861/futurehosp.6-1-52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Personal health records (PHRs) are thought to offer benefits and are promoted by health policy makers and some healthcare systems. Evidence for usage by patients in hospital is limited. This article reports a one-day workshop hosted by the Royal College of Physicians that considered the evidence of the value to patients and others, the challenges to adoption and use of PHRs and sought to identify the practical and research questions that need to be answered. The purpose of this article is to provide readers with an overview of the issues and possible future for hospital application of PHRs in the UK's NHS, especially for supporting self-care, family carers and advancing person-centred care. It aims to share the experience and ideas of those taking part in the workshop and reference resources that we have found useful while highlighting areas for future research.
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Affiliation(s)
| | | | - Nicola Quinn
- Health Informatics Unit, Royal College of Physicians, London, UK
| | - Jeremy C Wyatt
- Wessex Institute of Health & Research, Faculty of Medicine, University of Southampton, Southampton, UK
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Sparring V, Granström E, Andreen Sachs M, Brommels M, Nyström ME. One size fits none - a qualitative study investigating nine national quality registries' conditions for use in quality improvement, research and interaction with patients. BMC Health Serv Res 2018; 18:802. [PMID: 30342511 PMCID: PMC6195992 DOI: 10.1186/s12913-018-3621-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Swedish National Quality Registries (NQRs) are observational clinical registries that have long been seen as an underused resource for research and quality improvement (QI) in health care. In recent years, NQRs have also been recognised as an area where patients can be involved, contributing with self-reported experiences and estimations of health effects. This study aimed to investigate what the registry management perceived as barriers and facilitators for the use of NQRs in QI, research, and interaction with patients, and main activities undertaken to enhance their use for these purposes. The aim was further to identify potential differences between various types of NQRs for their use in these areas. METHODS In this multiple case study, nine NQRs were purposively selected. Interviews (n = 18) were conducted and analysed iteratively using conventional and directed content analysis. RESULTS A recent national investment initiative enabled more intensive work with development areas previously identified by the NQR management teams. The recent focus on value-based health care and other contemporary national healthcare investments aiming at QI and public benchmarking were perceived as facilitating factors. Having to perform double registrations due to shortcomings in digital systems was perceived as a barrier, as was the lack of authority on behalf of the registry management to request participation in NQRs and QI activities based on registry outcomes. The registry management teams used three strategies to enhance the use of NQRs: ensuring registering of correct and complete data, ensuring updated and understandable information available for patients, clinicians, researchers and others stakeholders, and intensifying cooperation with them. Varied characteristics of the NQRs influenced their use, and the possibility to reach various end-users was connected to the focus area and context of the NQRs. CONCLUSIONS The recent national investment initiative contributed to already ongoing work to strengthen the use of NQRs. To further increase the use, the demands of stakeholders and end-users must be in focus, but also an understanding of the NQRs' various characteristics and challenges. The end-users may have in common a need for training in the methodology of registry based research and benchmarking, and how to be more patient-centred.
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Affiliation(s)
- Vibeke Sparring
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden.
| | - Emma Granström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden
| | - Magna Andreen Sachs
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden
| | - Mats Brommels
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden
| | - Monica E Nyström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden.,Department of Public health and Clinical medicine, Epidemiology and Global health, Umeå University, SE-90187, Umeå, Sweden
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20
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21
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Patel AD, Fritz JV, Evans DA, Lundgren KB, Hentges K, Jones LK. Utilizing the Axon Registry® for quality improvement. Neurol Clin Pract 2018; 8:456-461. [PMID: 30564501 DOI: 10.1212/cpj.0000000000000516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/11/2018] [Indexed: 11/15/2022]
Abstract
In 2015, the American Academy of Neurology began development of a clinical quality data registry now known as the Axon Registry®. The data collected by the Axon Registry and reported back to participants include performance on a number of quality measures relevant to neurology practice. While the Axon Registry may serve any number of needs for neurology practices, the essential function of the registry is to inform neurologists regarding the quality of their care and provide them with a tool to establish not only performance baselines but progress toward improved quality of care. This article includes 2 case studies of how the Axon Registry has been implemented in neurology practices to date. In the future, implementation of patient-reported outcome data and additional outcome measures will be necessary to expand the reach and effectiveness of the Axon Registry as a quality improvement tool.
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Affiliation(s)
- Anup D Patel
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - Joseph V Fritz
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - David A Evans
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - Karen B Lundgren
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - Katie Hentges
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - Lyell K Jones
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
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22
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Granström E, Hansson J, Sparring V, Brommels M, Nyström ME. Enhancing policy implementation to improve healthcare practices: The role and strategies of hybrid national-local support structures. Int J Health Plann Manage 2018; 33:e1262-e1278. [PMID: 30091487 DOI: 10.1002/hpm.2617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 07/11/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In this study, we followed a national initiative to enhance the use of quality indicators gathered in national quality registries (NQRs) for improvement of clinical practices in Swedish healthcare, more specifically by investigating the support strategies of regional support centers with national and local missions. The aim was to increase knowledge on the role, challenges, and strategies of support structures with mixed and complex missions in the healthcare system. METHODS Documents and 25 semistructured interviews with staff at 6 regional support centers, ie, quality registry centers, formed this multiple case study. Data were analyzed using conventional content analysis. RESULTS The centers' strategies varied from developing the NQRs to become more suitable for improvement to supporting healthcare's use of NQRs, from the use of task to process-oriented support strategies, and from taking on national responsibilities to responding to local initiatives. All quality registry centers engaged in initiatives inspired by the Breakthrough Series approach. Some used preexisting change concepts or collaborated with local development units. A main challenge was to overcome a lack of formal mandate to act in the healthcare organizations they served. CONCLUSIONS Support functions with mixed and complex missions have to use a variation of strategies to reach relevant actors and achieve changes. This study provides valuable input for policy and decision-makers on the support strategies used and challenges of support functions with complex missions situated in-between national and local levels of the healthcare system, here denoted hybrid national-local support structures.
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Affiliation(s)
- Emma Granström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Johan Hansson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Vibeke Sparring
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Mats Brommels
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Monica Elisabeth Nyström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.,Department of Public health and Clinical medicine, Epidemiology and Global health, Umeå University, Umeå, Sweden
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McCulloch P, Feinberg J, Philippou Y, Kolias A, Kehoe S, Lancaster G, Donovan J, Petrinic T, Agha R, Pennell C. Progress in clinical research in surgery and IDEAL. Lancet 2018; 392:88-94. [PMID: 29361334 DOI: 10.1016/s0140-6736(18)30102-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
Abstract
The quality of clinical research in surgery has long attracted criticism. High-quality randomised trials have proved difficult to undertake in surgery, and many surgical treatments have therefore been adopted without adequate supporting evidence of efficacy and safety. This evidence deficit can adversely affect research funding and reimbursement decisions, lead to slow adoption of innovations, and permit widespread adoption of procedures that offer no benefit, or cause harm. Improvement in the quality of surgical evidence would therefore be valuable. The Idea, Development, Exploration, Assessment, and Long-term Follow-up (IDEAL) Framework and Recommendations specify desirable qualities for surgical studies, and outline an integrated evaluation pathway for surgery, and similar complex interventions. We used the IDEAL Recommendations to assess methodological progress in surgical research over time, assessed the uptake and influence of IDEAL, and identified the challenges to further methodological progress. Comparing studies from the periods 2000-04 and 2010-14, we noted apparent improvement in the use of standard outcome measures, adoption of Consolidated Standards of Reporting Trials (CONSORT) standards, and assessment of the quality of surgery and of learning curves, but no progress in the use of qualitative research or reporting of modifications during procedure development. Better education about research, integration of rigorous evaluation into routine practice and training, and linkage of such work to awards systems could foster further improvements in surgical evidence. IDEAL has probably contributed only slightly to the improvements described to date, but its uptake is accelerating rapidly. The need for the integrated evaluation template IDEAL offers for surgery and other complex treatments is becoming more widely accepted.
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Affiliation(s)
- Peter McCulloch
- Nuffiled Department of Surgical Science, University of Oxford, Oxford, UK.
| | - Joshua Feinberg
- Department of Surgery, Maimonides Hospital, Brooklyn, NY, USA
| | - Yiannis Philippou
- Nuffiled Department of Surgical Science, University of Oxford, Oxford, UK
| | - Angelos Kolias
- Division of Neurosurgery, School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - Sean Kehoe
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Gillian Lancaster
- Institute of Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Jenny Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tatjana Petrinic
- Cairns Library, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Riaz Agha
- Plastic Surgery Department, Guys and St Thomas' NHS Foundation Trust, London, UK
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Abstract
Introduction The use of information from clinical registries for improvement and value-based payment is increasing, yet information about registry use is not widely available. We conducted a landscape survey to understand registry uses, focus areas and challenges. The survey addressed the structure and organization of registry programs, as well as their purpose and scope. Setting The survey was conducted by the National Quality Registry Network (NQRN), a community of organizations interested in registries. NQRN is a program of the PCPI, a national convener of medical specialty and professional societies and associations, which constitute a majority of registry stewards in the United States. Methods We surveyed 152 societies and associations, asking about registry programs, governance, number of registries, purpose and data uses, data collection, expenses, funding and interoperability. Results The response rate was 52 percent. Many registries were self-funded, with 39 percent spending less than $1 million per year, and 32 percent spending $1-9.9 million. The typical registry had three full-time equivalent staff. Registries were frequently used for quality improvement, benchmarking and clinical decision support. 85 percent captured outpatient data. Most registries collected demographics, treatments, practitioner information and comorbidities; 53 percent captured patient-reported outcomes. 88 percent used manual data entry and 18 percent linked to external secondary data sources. Cost, interoperability and vendor management were barriers to continued registry development. Conclusions Registries captured data across a broad scope, audited data quality using multiple techniques, and used a mix of automated and manual data capture methods. Registry interoperability was still a challenge, even among registries using nationally accepted data standards.
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Brown WA, MacCormick AD, McNeil JJ, Caterson ID. Bariatric Surgery Registries: Can They Contribute to Improved Outcomes? Curr Obes Rep 2017; 6:414-419. [PMID: 29076029 DOI: 10.1007/s13679-017-0286-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Clinical registries systematically collect prospective information about patients with a particular medical condition, who have had a medical device implanted or who have undergone a particular procedure. When these variables are collected with pre-defined quality indices included, the benched-marked risk-adjusted data may be a valuable resource for providing feedback on outcomes, including performance, to practitioners, patients, health services and device manufacturers. RECENT FINDINGS There are examples of feedback from clinical registries positively influencing patient care. The Australian National Joint Registry identified a poorly performing hip prosthesis which was ultimately withdrawn from the market. Feedback from the Victorian State Prostate Cancer Registry has contributed to improved patient care and fewer positive surgical margins noted over a 5-year reporting period. There are several national and regional registries collecting information on patients undergoing bariatric surgery, however, few currently focus on quality outcome measures. Whilst, current bariatric registries have contributed to improved understanding of some of the clinical situations relating to bariatric surgery, as well as developing composite risk scores and measuring quality cultures, they have not as yet demonstrably directly influenced patient care. This may reflect the fact that many of the registries do not hold data that are mature enough for proper analysis, but may also reflect problems with systematic data collection, bias from missing results and lack of appropriate funding. It will be important in the future that bariatric surgery registries actively seek to measure and validate their contribution to patient outcomes.
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Affiliation(s)
- Wendy A Brown
- Bariatric Surgery Registry, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia.
- Monash University Department of Surgery, Alfred Hospital, Melbourne, Australia.
- Centre for Obesity Research and Education, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia.
| | - Andrew D MacCormick
- Bariatric Surgery Registry, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John J McNeil
- Bariatric Surgery Registry, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Ian D Caterson
- Bariatric Surgery Registry, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
- Boden Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
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Fredriksson M, Halford C, Eldh AC, Dahlström T, Vengberg S, Wallin L, Winblad U. Are data from national quality registries used in quality improvement at Swedish hospital clinics? Int J Qual Health Care 2017; 29:909-915. [DOI: 10.1093/intqhc/mzx132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/14/2022] Open
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Subbe C, Jeune IL, Ward D, Pradhan S, Masterton-Smith C. Impact of consultant specialty on discharge decisions in patients admitted as medical emergencies to hospitals in the United Kingdom. QJM 2017; 110:97-102. [PMID: 27795294 PMCID: PMC5939643 DOI: 10.1093/qjmed/hcw173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/02/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Society for Acute Medicine's Benchmarking Audit (SAMBA) annually examines Clinical Quality Indicators (CQIs) of the care of patients admitted to UK hospitals as medical emergencies. AIM The aim of this study is to review the impact of consultant specialty on discharge decisions in the SAMBA data-set. DESIGN AND METHODS Prospective audit of patients admitted to acute medical units (AMUs) on 25 June 2015 to participating hospitals throughout the UK with subgroup analysis. RESULTS Eighty-three units submitted patient data from 3138 patients.Nearly 1845 (58%, IQR for units 50-69%) of patients were referrals from Emergency Medicine, 1072 (32%, IQR for units 24-44%) were referrals from Primary Care. The mean age was 65 (SD 20). One hundred and forty-one (4.5%) patients were admitted from care homes and 951 (30%) of patients were at least 'mildly frail' and 407 (13%) had signs of physiological instability. The median and the mean time to being seen by a doctor were 1 h 20 min and 2 h 3 min, respectively. The median and the mean time to being seen by senior specialist were 3 h 55 min and 5 h 56 min, respectively. By 72 h, 29 (1%) patients had died in the AMU, 73 were admitted to critical care units, 1297 (41%) had been discharged to their own home and 60 to nursing or residential homes. For every 100 patients seen specialists in acute medicine discharged 12 more patients than specialists from other disciplines of medicine ( P < 0.001). The difference remained significant after adjustment for case mix. CONCLUSION Specialist in acute care might facilitate discharge in a higher proportion of patients.
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Affiliation(s)
- C.P. Subbe
- From Bangor University, School of Medical Sciences, Bangor, UK
| | - Ivan Le Jeune
- Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma (DREEAM), Nottingham University Hospitals NUH Trust, Nottingham, UK
| | - D. Ward
- Hinchingbrooke Health Care NHS Trust, Huntingdon, Cambridgeshire PE29 6NT, UK
| | - S. Pradhan
- Cochrane Building, University Hospital of Wales, Heath Park, Cardiff, Wales CF14 4YS, UK
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Eldh AC, Wallin L, Fredriksson M, Vengberg S, Winblad U, Halford C, Dahlström T. Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey. BMJ Open 2016; 6:e011562. [PMID: 28128099 PMCID: PMC5128910 DOI: 10.1136/bmjopen-2016-011562] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. METHODS Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. RESULTS A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with 'Colleagues' call for local results' (p=<0.001), 'Management Request of Registry data' (p=<0.001), and it was said to be 'Simple to explain the results to colleagues' (p=0.02). Using stepwise regression, 'Colleagues' call for local results' was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. CONCLUSIONS While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- School of Health and Social Science, Dalarna University, Falun, Sweden
| | - Lars Wallin
- School of Health and Social Science, Dalarna University, Falun, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sofie Vengberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Christina Halford
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tobias Dahlström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Brown WA, Smith BR, Boglis M, Brown DL, Anderson M, O'Brien PE, McNeil JJ, Caterson ID. Streamlining ethics review for multisite quality and safety initiatives: national bariatric surgery registry experience. Med J Aust 2016; 205:200-1. [DOI: 10.5694/mja16.00027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/22/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Wendy A Brown
- Monash University, Melbourne, VIC
- The Alfred Hospital, Melbourne, VIC
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30
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Petersson C, Huus K, Åkesson K, Enskär K. Children's experiences about a structured assessment of health-related quality of life during a patient encounter. Child Care Health Dev 2016; 42:424-32. [PMID: 26888733 DOI: 10.1111/cch.12324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/04/2015] [Accepted: 01/02/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been stated that care for children with chronic health conditions tends to focus on condition-specific issues rather than how these children experience their health and everyday life functioning. AIM The aim of this study was to explore children's experiences about a structured assessment of health-related quality of life applied during a patient encounter. METHODS Prior to the start of the study, a clinical intervention based on the questionnaire DISABKIDS Chronic Generic Measure (DCGM-37) was performed. A qualitative explorative design was chosen, and 25 children between 10-17 years of age were interviewed after the consultation at four different paediatric outpatient clinics. Data were analysed according to qualitative content analysis. RESULTS The results were twofold: children experienced that the assessment was providing them with insights about their health, which motivated them to make lifestyle changes. When outcomes were discussed and requested, the children felt encouraged. CONCLUSIONS The use of an assessment of health-related quality of life may promote insights about health and encourage children with chronic health conditions to discuss their outcomes with healthcare professionals.
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Affiliation(s)
- C Petersson
- School of Health and Welfare, Research School of Health and Welfare, Jönköping University and The Jönköping Academy for Improvement of Health and welfare, CHILD Research Group, Jönköping, Sweden
| | - K Huus
- School of Health and Welfare, Research School of Health and Welfare, Jönköping University and The Jönköping Academy for Improvement of Health and welfare, CHILD Research Group, Jönköping, Sweden.,Department of Nursing, School of Health and Welfare, Jönköping University, Sweden
| | - K Åkesson
- School of Health and Welfare, Research School of Health and Welfare, Jönköping University and The Jönköping Academy for Improvement of Health and welfare, CHILD Research Group, Jönköping, Sweden.,The Jönköping Academy for Improvement of Health and welfare, Jönköping University and Futurum, Academy for Health and Care, Jönköping County, Sweden
| | - K Enskär
- Department of Nursing, School of Health and Welfare, Jönköping University, Sweden
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Affiliation(s)
- J F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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