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Collaboratively improving diabetes care in Sweden using a national quality register: Successes and challenges: a case study

Journal article
Authors Anette Peterson
Soffia Gudbjörnsdottir
U. B. Lofgren
Linus Schiöler
M. Bojestig
J. Thor
B. A. Gare
Published in Quality Management in Health Care
Volume 24
Issue 4
Pages 212-221
ISSN 1063-8628
Publication year 2015
Published at Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 212-221
Language en
Keywords Collaborative, Diabetes mellitus, Guideline adherence, Quality improvement, Registries
Subject categories Diabetology, Public Health, Global Health, Social Medicine and Epidemiology


Background: Since 1996, the Swedish National Diabetes Register (NDR) enabled health care providers to monitor their clinical performance over time and compare it with the national average. All health systems of Swedish county councils report data. By 2014, the NDR included data from 360 000 patients. Comparisons among county councils show significant variations in clinical outcomes and in adherence to evidence-based national guidelines. The purpose of this study was to evaluate whether and how a quality improvement collaborative could influence clinical practice and outcomes. Methods: Twenty-three diabetes teams from all over Sweden, both primary care units and internal medicine departments, joined a quality improvement collaborative. The project was inspired by the Breakthrough Collaborative Model and lasted for 20 months. Evaluation data were collected from the teams' final reports and the NDR throughout the study period. Results and Conclusion: The teams reported improved patient outcomes significantly compared with the national average for systolic blood pressure and low-density lipoprotein levels. In contrast, glycated hemoglobin A1c levels deteriorated in the whole NDR population. Five themes of changes in practice were tested and implemented. Success factors included improved teamwork, with active use of register data, and testing new ideas and learning from others. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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