Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BMC Health Services Research

Ulrika Winblad²  Sofie Vengberg²  Tobias Dahlström²  Lars Wallin¹  Christina Halford²  Mio Fredriksson²  Ann Catrine Eldh¹ 

[1] School of Education, Health, and Social Studies, Dalarna University, SE 791 88 Falun, Sweden;Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

关键词: Quality improvement;    National quality registry;    Facilitation;    Evidence based practice;   

Others  :  1126685
DOI  :  10.1186/1472-6963-14-354

 received in 2014-04-11, accepted in 2014-08-18,  发布年份 2014

【 摘 要 】

Background

National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden.

Methods

A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR’s criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis.

Results

An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data.

Conclusion

While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

【 授权许可】

   
2014 Eldh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Schwamm L, Reeves MJ, Frankel M: Designing a sustainable national registry for stroke quality improvement. Am J Prev Med 2006, 31(6 Suppl 2):S251-S257.
• [2]Siriwardena AN, Shaw D, Donohoe R, Black S, Stephenson J, National Ambulance Clinical Audit Steering Group: Development and pilot of clinical performance indicators for English ambulance services. Emerg Med J 2010, 27(4):327-331.
• [3]Cadilhac DA, Lannin NA, Anderson CS, Levi CR, Faux S, Price C, Middleton S, Lim J, Thrift AG, Donnan GA: Protocol and pilot data for establishing the Australian Stroke Clinical Registry. Int J Stroke 2010, 5(3):217-226.
• [4]Sveriges Kommuner och Landsting [Swedish Association of Local Authorities and Regions]: Översyn av de nationella kvalitetsregistren. Guldgruvan i hälso- och sjukvården. Förslag till gemensam satsning 2011–2015. [Review of the national quality registries. The gold mine in health care. Proposal for a common investment]. Stockholm: SKL; 2010.
• [5]Drolet BC, Johnson KB: Categorizing the world of registries. J Biomed Inform 2008, 41(6):1009-1020.
• [6]Nightingale F: Notes on Hospitals. London: Longman, Green, Longman, Roberts, and Green; 1863.
• [7]World Health Organization: Bridging the “Know–Do” Gap Meeting on Knowledge Translation in Global Health. Geneva: WHO; 2006.
• [8]Grol R, Grimshaw J: Evidence-based implementation of evidence-based medicine. Jt Comm J Qual Improv 1999, 25(10):503-513.
• [9]Batalden PB, Davidoff F: What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care 2007, 16(1):2-3.
• [10]Rycroft-Malone J: The PARIHS framework–a framework for guiding the implementation of evidence-based practice. J Nurs Care Qual 2004, 19(4):297-304.
• [11]Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A: Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci 2008, 3(1):1.
• [12]Creswell JW, Plano Clark VL: Designing and Conducting Mixed Methods Research. 2nd edition. New York: Sage; 2011.
• [13]Elo S, Kyngas H: The qualitative content analysis process. J Adv Nurs 2008, 62(1):107-115.
• [14]Asplund K, Hulter Åsberg K, Appelros P, Bjarne D, Eriksson M, Johansson A, Jonsson F, Norrving B, Stegmayr B, Terént A, Wallin S, Wester PO: The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care. Int J Stroke 2011, 6(2):99-108.
• [15]Riksstroke http://riksstroke.org webcite
• [16]Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, Estabrooks C: Ingredients for change: revisiting a conceptual framework. Qual Saf Health Care 2002, 11(2):174-180.
• [17]Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004, 24(2):105-112.
• [18]Cadilhac DA, Moss KM, Price CJ, Lannin NA, Lim JY, Anderson CS: Pathways to enhancing the quality of stroke care through national data monitoring systems for hospitals. Med J Aust 2013, 199(10):650-651.
• [19]Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J, Oxman AD: Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012, 6:CD000259.
• [20]Carlhed R, Bellman C, Bojestig M, Bojö L, Peterson A, Lindahl B: Quality improvement in coronary care: analysis of sustainability and impact on adjacent clinical measures after a Swedish controlled, multicenter quality improvement collaborative. J Am Heart Assoc 2012, 1(4):e000737.
• [21]Thompson DS, O’Leary K, Jensen E, Scott-Findlay S, O’Brien-Pallas L, Estabrooks CA: The relationship between busyness and research utilization: it is about time. J Clin Nurs 2008, 17(4):539-548.
• [22]Rogers EM: Diffusion of Innovations. 5th edition. New York: Free Press; 2003.
• [23]McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K: Getting evidence into practice: the meaning of ‘context’. J Adv Nurs 2002, 38(1):94-104.
• [24]Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A: An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs 2004, 13(8):913-924.
• [25]Centers for Disease, Control, and Prevention: Use of a registry to improve acute stroke care - seven states, 2005–2009. MMWR Morb Mortal Wkly Rep 2011, 60(7):206-210.
• [26]Gardulf A, Orton ML, Eriksson LE, Undén M, Arnetz B, Kajermo KN, Nordström G: Factors of importance for work satisfaction among nurses in a university hospital in Sweden. Scand J Caring Sci 2008, 22(2):151-160.
• [27]von Vultée PJ, Axelsson R, Arnetz B: The impact of organisational settings on physician wellbeing. Int J Health Care Qual Assur 2007, 20(6):506-515.
• [28]Stecksén A, Lundman B, Eriksson M, Glader EL, Asplund K: Implementing thrombolytic guidelines in stroke care: perceived facilitators and barriers. Qual Health Res 2014, 24(3):412-419.
• [29]Wallin L, Målqvist M, Nga NT, Eriksson L, Persson LÅ, Hoa DP, Huy TQ, Duc DM, Ewald U: Implementing knowledge into practice for improved neonatal survival; a cluster-randomised, community-based trial in Quang Ninh province Vietnam. BMC Health Serv Res 2011, 11:239.
• [30]Seers K, Cox K, Crichton NJ, Edwards RT, Eldh AC, Estabrooks CA, Harvey G, Hawkes C, Kitson AL, Linck P, McCarthy G, McCormack B, Mockford C, Rycroft-Malone R, Titchen A, Wallin L: Facilitating Implementation of Research Evidence (FIRE): a study protocol. Implement Sci 2011, 7:25.
• [31]Bergström A, Peterson S, Namusoko S, Waiswa P, Wallin L: Knowledge translation in Uganda: a qualitative study of Ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework. Implement Sci 2012, 7:117.
• [32]Helfrich C, Damschroder L, Hagedorn H, Daggett G, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich P, Stetler C: A critical synthesis of literature on the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implement Sci 2010, 5:82.
• [33]Rycroft-Malone J, Seers K, Chandler J, Hawkes CA, Crichton N, Allen C, Bullock I, Strunin L: The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implement Sci 2013, 8:28.
• [34]Rycroft-Malone J, Seers K, Crichton N, Chandler J, Hawkes CA, Allen C, Bullock I, Strunin L: A pragmatic cluster randomised trial evaluating three implementation interventions. Implement Sci 2012, 7(1):80.
• [35]Stetler CB, Damschroder LJ, Helfrich CD, Hagedorn HJ: A guide for applying a revised version of the PARIHS framework for implementation. Implement Sci 2011, 6:99.
• [36]Ullrich PM, Sahay A, Stetler CB: Use of implementation theory: a focus on PARIHS. Worldviews Evid Based Nurs 2014, 11(1):26-34.
• [37]Rycroft-Malone J, Bucknall T: Models and Frameworks for Implementing Evidence-Based Practise: Linking Evidence to Action. Chichester: Wiley-Blackwell; 2010.