Enhancing policy implementation to improve healthcare practices: The role and strategies of hybrid national‐local support structures

Granström, Emma; Hansson, Johan; Sparring, Vibeke; Brommels, Mats; Nyström, Monica

doi:10.1002/hpm.2617

Cited by 9 publications

(13 citation statements)

References 33 publications

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“…The importance of the National Quality Registries in guiding healthcare policies in Sweden was recently re-emphasised 50. In order to guide decisions on matters of healthcare, national and international registries must offer reliable information.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes for eating disorders in Sweden: data from the national quality registry

et al. 2019

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ObjectiveTo report the outcomes of eating disorders treatment in Sweden in 2012–2016.DesignThe number of patients treated and the number of patients not fulfilling an eating disorders diagnosis (remission) at 1 year of follow-up at the clinics listed in the National Quality Registry for Eating Disorders Treatment were analysed. The published outcomes at three clinics, which used survival analysis to estimate outcomes, were compared with their outcomes in the registry. Outcomes at the three biggest clinics were compared.SettingAll eating disorders clinics.ParticipantsAll patients treated at eating disorders clinics.InterventionCognitive–behavioural therapy at most clinics and normalisation of eating behaviour at the three clinics with published outcomes.Outcome measureProportion of patients in remission.ResultsAbout 2600 patients were treated annually, fewer than half were followed up and remission rates decreased from 21% in 2014 to 14% in 2016. Outcomes, which differed among clinics and within clinics over time, have been publicly overestimated by excluding patients lost to follow-up. The published estimated rate of remission at three clinics that treated 1200 patients in 1993–2011 was 27%, 28% and 40% at 1 year of follow-up. The average rate of remission over the three last years at the biggest of these clinics was 36% but decreased from 29% and 30% to 16 and 14% at the two other of the biggest clinics.ConclusionsWith more than half the patients lost to follow-up and no data on relapse in the National Quality Registry, it is difficult to estimate the effects of eating disorders treatment in Sweden. Analysis of time to clinically significant events, including an extended period of follow-up, has improved the quality of the estimates at three clinics. Overestimation of remission rates has misled healthcare policies. The effect of eating disorders treatment has also been overestimated internationally.

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Section: Discussionmentioning

confidence: 99%

Treatment outcomes for eating disorders in Sweden: data from the national quality registry

et al. 2019

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“…The consequences of working with the NQRs on the work situation are an important issue, especially in care of older people. Previous research on NQRs in health care has mainly focused on the effects of medical and care interventions in a disease area and/or on the care process and more recently on conditions for their use (Eldh et al., 2005; Granström, Hansson, Sparring, Brommels, & Nyström, 2018; Sparring, Granström, Andreen Sachs, Brommels, & Nyström, 2018). How staff's work situation is affected by work with NQRs has been less studied and no such study has focused specifically on care of older people.…”

Section: Introductionmentioning

confidence: 99%

Working with national quality registries in older people care: A qualitative study of perceived impact on assistant nurses’ work situation

et al. 2020

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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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“…The latter is considered to be more developed in terms of feedback with national benchmarks and validation of data 6. Such a degree of maturity has been suggested as a possible explanation for differences in use of data between registries 5 6 27…”

Section: Discussionmentioning

confidence: 99%

Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database

et al. 2019

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ObjectivesTo investigate use of data from a clinical quality registry for cardiac rehabilitation in Denmark, considering the extent to which data are used for local quality improvement and what facilitates the use of these data, with a particular focus on whether there are differences between frontline staff and managers.DesignCross-sectional nationwide survey study.Setting, methods and participantsA previously validated, Swedish questionnaire regarding use of data from clinical quality registries was translated and emailed to frontline staff, mid-level managers and heads of departments (n=175) in all 30 hospital departments participating in the Danish Cardiac Rehabilitation Database. Data were analysed descriptively and through multiple linear regression.ResultsSurvey response rate was 58% (101/175). Reports of registry use at department level (measured through an index comprising seven items; score min 0, max 7, where a low score indicates less use of data) varied significantly between groups of respondents: frontline staff mean score 1.3 (SD=2.0), mid-level management mean 2.4 (SD=2.3) and heads of departments mean 3.0 (SD=2.5), p=0.006. Overall, department level use of data was positively associated with higher perceived data quality and usefulness (regression coefficient=0.22, p=0.019), management request for data (regression coefficient=0.40, p=0.008) and personal motivation of the respondent (regression coefficient=1.63, p<0.001). Among managers, use of registry data was associated with data quality and usefulness (regression coefficient=0.43, p=0.027), and among frontline staff, reported data use was associated with management involvement in quality improvement work (regression coefficient=0.90, p=0.017) and personal motivation (regression coefficient=1.66, p<0.001).ConclusionsThe findings suggest relatively sparse use of data in local quality improvement work. A complex interplay of factors seem to be associated with data use with varying aspects being of importance for frontline staff and managers.

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Enhancing policy implementation to improve healthcare practices: The role and strategies of hybrid national‐local support structures

Cited by 9 publications

References 33 publications

Treatment outcomes for eating disorders in Sweden: data from the national quality registry

Treatment outcomes for eating disorders in Sweden: data from the national quality registry

Working with national quality registries in older people care: A qualitative study of perceived impact on assistant nurses’ work situation

Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database

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