Use of national clinical databases for informing and for evaluating health care policies

Black, Nick; Tan, Stefanie

doi:10.1016/j.healthpol.2012.10.007

Cited by 21 publications

(13 citation statements)

References 8 publications

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“…Although there is evidence of some clinical organisations using registers, competence in improvement based on registers is generally low [2]. Doubts have been raised about whether registers are used for evaluating services at clinical practice level [3]. The central problem is therefore not registers as such, but how to make them useful in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

The role of professional logics in quality register use: a realist evaluation

Norman

Elg

Nordin

et al. 2020

BMC Health Serv Res

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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 contextsregistration, use of output data, governance, and improvement projectsthat 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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Section: Introductionmentioning

confidence: 99%

The role of professional logics in quality register use: a realist evaluation

Norman

Elg

Nordin

et al. 2020

BMC Health Serv Res

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“…Em alguns países, por exemplo na Inglaterra, muitos bancos de dados clínicos e gerenciais são disponibilizados para subsidiar pesquisas científicas que apoiem as decisões em saúde. 31 Comparando o protocolo adaptado a outros publicados internacionalmente para avaliar a gestão e governança dos sistemas de saúde, percebe-se similaridades de princípios como os de visão estratégica, participação na tomada de decisões e transparência. 32, 33 , 34 Já quanto a aspectos "éticos", não foi possível incluir no PAGAF, pois as informações disponíveis no banco de dados da PNAUM não permitiam tal avaliação.…”

Section: Discussionunclassified

Desenvolvimento de um protocolo de indicadores para avaliação nacional da capacidade de gestão da Assistência Farmacêutica na Atenção Primária à Saúde

et al. 2020

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Objetivo: Descrever as etapas da adaptação de um protocolo de indicadores para a avaliação da capacidade de gestão da Assistência Farmacêutica a partir das variáveis constantes em um banco de dados nacional. Métodos: Estudo sistemático por meio da convergência de um protocolo de indicadores de avaliação da capacidade de gestão da assistência farmacêutica a nível municipal com dados oriundos da Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos, para elaboração de um protocolo de indicadores de abrangência nacional. Após a adaptação e análise preliminar do protocolo, um estudo de consenso foi realizado em duas etapas: consulta com especialistas e oficina de consenso. Na sequência foi realizado um teste de aplicabilidade do protocolo de indicadores com os dados disponíveis pela pesquisa nacional. Resultados: Entre os indicadores, 17 sofreram alterações e em seis foram alteradas as fontes de coleta de dados. Devido à ausência de informações necessárias para aplicar as medidas preconizadas, 16 indicadores foram excluídos do protocolo original. Ao final, o protocolo proposto foi composto por 30 indicadores organizados em três dimensões: Organizacional, Operacional e Sustentabilidade. Conclusão: Os resultados da validação da aplicabilidade dos indicadores, com base nos dados nacionais, asseguram a sensibilidade do novo protocolo de avaliação no contexto dos serviços farmacêuticos na atenção primária. O novo protocolo permite, assim, avaliar a capacidade de gestão da Assistência Farmacêutica em municípios brasileiros sem prejuízo das premissas que sustentaram o modelo original. O protocolo viabilizará avaliações futuras, sugerindo-se a possível institucionalização destes indicadores para monitoramento contínuo da Assistência Farmacêutica no Brasil. Os resultados deste processo podem ser adotados como ponto de partida para o desenvolvimento de indicadores de capacidade de gestão dos serviços farmacêuticos também em outros países.Palavras-Chave: Avaliação em Saúde, Gestão em Saúde, Assistência Farmacêutica, PNAUM Development of a protocol of indicators for national evaluation of the management capacity of Pharmaceutical Services in Primary Health CareABSTRACTObjective: To describe the stages of adaptation of an indicator protocol for the evaluation of Pharmaceutical Services management capacity from the variables in a national database. Methods: Systematic study through the convergence of a protocol of indicators of evaluation of the management capacity of pharmaceutical services at municipal level with data from the National Survey of Access, Use and Promotion of the Rational Use of Medicines, to elaborate a protocol of indicators. nationwide. After adaptation and preliminary analysis of the protocol, a consensus study was carried out in two steps: consultation with experts and consensus workshop. Subsequently, an applicability test of the indicator protocol was performed with data available from the national survey. Results: Among the indicators, 17 suffered alterations and in six the sources of data collection were altered. Due to the lack of information necessary to implement the recommended measures, 16 indicators were excluded from the original protocol. In the end, the proposed protocol was composed of 30 indicators organized in three dimensions: Organizational, Operational and Sustainability. Conclusions: The results of validating the applicability of the indicators, based on national data, ensure the sensitivity of the new assessment protocol in the context of pharmaceutical services in primary care. Thus, the new protocol allows us to evaluate the Pharmaceutical Services management capacity in Brazilian municipalities, without prejudice to the assumptions that supported the original model. The protocol will enable future evaluations, suggesting the possible institutionalization of these indicators for continuous monitoring of Pharmaceutical Services in Brazil. The results of this process can be taken as a starting point for the development of pharmaceutical services management capacity indicators also in other countries.KEYWORDS: Health Evaluation, Health Management, Pharmaceutical Services, PNAUM

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“…39 These large data sets can provide more useful safety information that is often lacking in controlled, short-term prospective trials, and studies have subsequently used these data sets to answer important clinical questions. 40,41 In addition, registries with linked clinical data (eg, National Cardiovascular Data Registry registries) can also provide information on potential misuse of a device; for example, many studies have found that too many transcatheter aortic valve implantations are being conducted in a transapical fashion than would be expected for a typical patient population.…”

Section: Postapproval Surveillance Strategiesmentioning

confidence: 99%