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  • 1.
    Fredriksson, Mio
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Halford, Christina
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Eldh, Ann Catrine
    Dalarna University, Sweden; Uppsala University, Sweden.
    Dahlström, Tobias
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Vengberg, Sofie
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wallin, Lars
    School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Are data from national quality registries used in quality improvement at Swedish hospital clinics?2017Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, nr 7, s. 909-915Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden.

    Design

    Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level).

    Setting and Participants

    Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR).

    Main Outcome Measure(s)

    Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation.

    Results

    Riksstroke data were reported as most extensively used at individual and unit levels ( x̅ 17.97 of 24 and x̅ 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs ( x̅ 19.86 for Riksstroke and x̅ 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks ( x̅ 12.90 and x̅ 13.28 of 20) while the least developed registry, the NLCR, had lower estimates ( x̅ 10.32). In Riksstroke, the managers requested registry data more often ( x̅ 15.17 of 20).

    Conclusions

    While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry’s level of development and factors important for routinization of innovations such as NQRs needs investigation.

  • 2.
    Hallgren Elfgren, Ing-Marie
    et al.
    Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Törnvall, Eva
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Grodzinsky, Ewa
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    The process of implementation of the diabetes register in Primary Health Care2012Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 24, nr 4, s. 419-424Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Quality problem or issue According to Swedish law, all health care units must have a system for quality improvement. The aim of this study was to follow an implementation process of a uniform routine for quality control of diabetes care in Primary Health Care in one county.                    

    Initial assessment Primary Health Care had a decentralized organization and patients with type 2 diabetes were served at 42 different Primary Health Care Centres.                    

    Choice of solution As the Swedish Diabetes Register (National Diabetes Register, NDR) holds the most important quality indicators, implementation of the NDR registration at all centres was chosen to be the best way to follow up quality in diabetes care.                    

    Implementation The process of implementing the NDR went through different phases and the main way to encourage commitment to the process was to reward performance in a progressively more differentiated way.                    

    Evaluation During the implementation process (2001–05) there was an increasing rate of registration. When the programme ceased, the registration rate had reached a level of 75%, which has remained stable and was still in 2010 one of the highest rates in                        Sweden.                    

    Lessons learned Important factors for success were the initiative taken by the profession itself and strong support from the leaders of the county council. It was also important to let the process develop gradually in order to get all staff involved. Among the outcomes was an increase in computer use in clinical practice among the diabetes nurse specialists and a structured way of encouraging the patients' participation in self-care.                    

                   

  • 3.
    Kredo, Tamara
    et al.
    S African MRC, South Africa.
    Bernhardsson, Susanne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Narhalsan Rehabil, Sweden.
    Machingaidze, Shingai
    S African MRC, South Africa.
    Young, Taryn
    S African MRC, South Africa; University of Stellenbosch, South Africa.
    Louw, Quinette
    University of Stellenbosch, South Africa.
    Ochodo, Eleanor
    University of Stellenbosch, South Africa.
    Grimmer, Karen
    University of Stellenbosch, South Africa; University of S Australia, Australia.
    Guide to clinical practice guidelines: the current state of play2016Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 28, nr 1, s. 122-128Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Extensive research has been undertaken over the last 30 years on the methods underpinning clinical practice guidelines (CPGs), including their development, updating, reporting, tailoring for specific purposes, implementation and evaluation. This has resulted in an increasing number of terms, tools and acronyms. Over time, CPGs have shifted from opinion-based to evidence-informed, including increasingly sophisticated methodologies and implementation strategies, and thus keeping abreast of evolution in this field of research can be challenging. Methods: This article collates findings from an extensive document search, to provide a guide describing standards, methods and systems reported in the current CPG methodology and implementation literature. This guide is targeted at those working in health care quality and safety and responsible for either commissioning, researching or delivering health care. It is presented in a way that can be updated as the field expands. Conclusion: CPG development and implementation have attracted the most international interest and activity, whilst CPG updating, adopting (with or without contextualization), adapting and impact evaluation are less well addressed.

  • 4.
    Lindberg, Malou
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Ahlner, Johan
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Ekström, Tommy
    Linköpings universitet, Institutionen för medicin och vård, Lungmedicin. Linköpings universitet, Hälsouniversitetet.
    Möller, Margareta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Linköpings universitet, Hälsouniversitetet.
    Patient questionnaires in primary health care: Validation of items used in asthma care2000Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 12, nr 1, s. 19-24Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective.To evaluate each item in a patient questionnaire for the purpose of investigating whether the validity of each item is acceptable.

    Design.The questionnaire was completed by the patients at an ordinary follow-up visit for their asthma, and within 1 week a nurse interviewed them by telephone with the aim of analysing the validity of each item through the use of predetermined criteria.

    Settings.Patients with asthma in primary health care settings in Sweden.

    Study participants.Fifty-one patients were consecutively included from three different primary health care units.

    Results.Nine of 13 items had an acceptable validity. The four items that were not found to have acceptable validity were developed further.

    Conclusion.Evaluating each item in a questionnaire by means of interviews with the specific patient population is a useful method of assuring that the intention of the patient questionnaire has been met.

  • 5.
    Lindberg, Malou
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Ekstrom, Tommy
    Linköpings universitet, Institutionen för medicin och vård, Lungmedicin. Linköpings universitet, Hälsouniversitetet.
    Moller, Margareta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Linköpings universitet, Hälsouniversitetet.
    Ahlner, Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Asthma care and factors affecting medication compliance: the patient's point of view2001Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 13, nr 5, s. 375-383Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To identify important factors that can influence patient compliance with prescribed medication and to elucidate aspects of asthma care from the patient's point of view.

    Design. Field investigation; the interviewer used a semi‐structured questionnaire.

    Setting. Patients with asthma in primary health care settings in Sweden.

    Study participants. A sample of 77 patients was randomly selected from 11 primary health care centres in southern Sweden; 63 of these patients participated in the study.

    Conclusion. The factors of importance for self‐reported compliance with prescribed medication were age, gender, duration of the disease, the attitude of the staff and information/education about asthma. The patients expressed important aspects of care, and these are in accordance with how an asthma nurse practice functions in Sweden.

  • 6.
    Lindberg, Malou
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Ekström, Tommy
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Lungmedicin. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Lungmedicinska kliniken US.
    Möller, Margareta
    Ahlner, Johan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi.
    Astma care and factors affectin medication comliance; the patient's point of view2001Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 13, s. 375-383Artikkel i tidsskrift (Fagfellevurdert)
  • 7.
    Lindberg, Malou
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Lind, Mildrid
    Petersson, Susanne
    Wilhelmsson, Susan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för vård och välfärd. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    The use of clinical guidelines for asthma, diabetes, and hypertension in primary health care2005Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 17, s. 217-220Artikkel i tidsskrift (Fagfellevurdert)
  • 8.
    Lindgren, Margareta
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Andersson, Inger S
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    The Karen instruments for measuring quality of nursing care: construct validity and internal consistency.2011Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, nr 3, s. 292-301Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Valid and reliable instruments for measuring the quality of care are needed for evaluation and improvement of nursing care. Previously developed and evaluated instruments, the Karen-patient and the Karen-personnel based on Donabedian's Structure–Process–Outcome triad (S–P–O triad) had promising content validity, discriminative power and internal consistency.

    Objective The objective of this study was to further develop the instruments with regard to construct validity and internal consistency.

    Design and Settings This prospective study was carried out in medical and surgical wards at a hospital in Sweden. A total of 95 patients and 120 personnel were included.

    Methods The instruments were tested for construct validity by performing factor analyses in two steps and for internal consistency using Cronbach's alpha coefficient.

    Results The first confirmatory factor analyses, with a pre-determined three-factor solution did not load well according to the S–P–O triad, but the second exploratory factor analysis with a six-factor solution appeared to be more coherent and the distribution of variables seemed to be logical. The reliability, i.e. internal consistency, was good in both factor analyses.

    Conclusions The Karen-patient and the Karen-personnel instruments have achieved acceptable levels of construct validity. The internal consistency of the instruments is good. This indicates that the instruments may be suitable to use in clinical practice for measuring the quality of nursing care.

  • 9.
    Nilsson, Erik
    et al.
    Department of Surgery, Motala Hospital, Motala.
    Ros, Axel
    Department of Surgery, Ryhov County Hospital, Jönköping.
    Rahmqvist, Mikael
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Bäckman, Karin
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Cholecystectomy: costs and health-related quality of life: a comparison of two techniques2004Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 16, nr 6, s. 473-482Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Outcomes of previous health economic evaluations comparing minilaparotomy cholecystectomy and laparoscopic cholecystectomy have been inconsistent.

    Objective. To compare costs for minilaparotomy cholecystectomy and laparoscopic cholecystectomy and to study changes in quality of life induced by these operations.

    Design. Single-blind, randomized controlled trial, run from 1 March 1997 to 30 April 1999.

    Setting. One university hospital and four non-university hospitals in Sweden.

    Main measures. Cost and perceived health estimation according to the global quality of life instrument EuroQol-5D.

    Results. Of 1719 cholecystectomy patients at five centres, 724 entered the trial and were treated with minilaparotomy cholecystectomy or laparoscopic cholecystectomy, 362 in each group. Total health care costs were less for minilaparotomy cholecystectomy than for laparoscopic cholecystectomy (median values US$2428 for minilaparotomy cholecystectomy versus US$2613 or US$3006 for laparoscopic cholecystectomy with 100 operations per year and reusable trocars or 50 operations per year and disposable trocars, respectively). There was no significant difference in total costs (including costs due to loss of production) between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with 100 operations per year and reusable trocars in laparoscopic cholecystectomy (US$3731 versus US$3649, respectively). However, in calculations assuming 50 operations per year and disposable trocars in laparoscopic cholecystectomy, this technique was more expensive than minilaparotomy cholecystectomy (US$4042 versus US$3731). Health-related quality of life was slightly but significantly lower for the minilaparotomy cholecystectomy group 1 week after surgery. One month and 1 year postoperatively no difference between the randomized groups was found.

    Conclusion. Total costs did not differ between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with high-volume surgery and disposable trocars, whereas laparoscopic cholecystectomy was more expensive with fewer operations and disposable trocars. The gain in health-related quality of life with laparoscopic cholecystectomy compared with minilaparotomy cholecystectomy was small and of limited duration.

  • 10.
    Rahmqvist, Mikael
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och miljö.
    Patient satisfaction in relation to age, health status and other background factors: A model for comparisons of care units2001Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 13, nr 5, s. 385-390Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To analyse the relationship between patient satisfaction and background factors such as age, gender, health status and pain. In addition, to use background factors to create less biased ranking in comparisons of patient satisfaction between medical specialities. Design. A questionnaire was sent by post to patients who had recently received inpatient care at a hospital within the County of ╓sterg÷tland, Sweden. The questionnaire contained 33 questions, 21 of which concerned the quality of health care and patient satisfaction. Setting. Inpatient departments at all four hospitals in the County of ╓sterg÷tland, Sweden. Subjects. All patients discharged from the hospital during a period of 6 weeks. Approximately 3400 patients aged 1-94 years responded to the questionnaire, resulting in a response rate of 69%. Main outcome measures. Patient satisfaction index score (PSI). Results. Of the background factors tested, patient age had the greatest explanatory value regarding the PSI, closely followed by experiencing anxiety during admission. With regard to variations in the PSI, about 20% could be explained by the background factors taken as a whole. Gender did not correlate with the PSI, although males were somewhat more satisfied than females. PSI scores differed among medical specialities and, interestingly, when age and other background factors were controlled for, the picture changed regarding the medical speciality that received the best PSI score. Conclusion. The change in ranking among medical specialities after adjustment for background factors emphasizes the importance of including background factors in patient satisfaction analyses in order to obtain less biased comparisons.

  • 11.
    Stenlund, Marie
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Yngman Uhlin, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Linköpings universitet, Medicinska fakulteten.
    Incidence and potential risk factors for hospital-acquired pneumonia in an emergency department of surgery2017Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, nr 2, s. 290-294Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Hospital-acquired pneumonia (HAP) is associated with high mortality and is the second most common nosocomial infection. The aim of this study was to calculate the incidence and to identify potential risk factors for HAP in an emergency ward for surgical patients admitted because of acute abdomen or trauma. A structured review of medical records was conducted. Patients diagnosed with pneumonia amp;gt; 48 h after admittance, were compared with a randomly chosen age-matched reference group. Ten variables judged as potential risk factors for HAP were studied in 90 patients. An emergency ward for surgical patients with acute abdomen or trauma at an Univerity hospital in Sweden. A total of 90 patients with HAP and 120 age-matched controls were included. Risk factors for HAP in patients at a surgical clinic. Of a total of 10 335 admitted patients, during 4.5 years the hospital stay was longer than 48 h in 4961 patients. Of these 90 (1.8%) fulfilled the strict criteria for HAP. Potential risk factors were suspected or verified aspiration (odds ratio (OR): 23.9) that was 2-fold higher than immobilization (OR: 11.2). Further, chronic pulmonary obstructive disease (COPD)/asthma, abdominal surgery and gastric retention/vomiting were risk factors for HAP. Verified or suspected aspiration was the dominating risk factor for HAP but also immobilization was frequently associated with HAP. Various established preventive measures should be implemented in the nursing care to reduce the frequency of HAP.

  • 12.
    Wallin, L
    et al.
    Falun.
    Boström, A
    Falun.
    Harvey, G
    Falun.
    Wikblad, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad.
    Ewald, U
    Falun.
    National guidelines for Swedish neonatal nursing care: Evaluation of clinical application.2000Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 12, s. 465-474Artikkel i tidsskrift (Fagfellevurdert)
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