The Investment in National Quality Registers

Over a period of five years, the Swedish Government and the authorities responsible for healthcare will jointly invest just over SEK 1.5 billion on the development of the National Quality Registers. The Swedish Agency for Health and Care Services Analysis (Vårdanalys) has been commissioned by the Swedish Government to draw up an evaluation plan for this investment. The evaluation will be based on the agreement for National Quality Registers that has been reached between the Government and the Swedish Association of Local Authorities and Regions (SALAR). This report describes the evaluation plan proposed by Vårdanalys.

EVALUATION MODEL PROPOSAL BY VÅRDANALYS 

The proposal by Vårdanalys aims to evaluate how all the links in the organisation, resource and efforts chain have worked to achieve the purposes and targets of the investment in an effective manner. Vårdanalys therefore proposes an evaluation containing three blocks (see diagram below):

Block 1: Main evaluation of whether the investment is achieving its goals 

In the main evaluation, we will initially review the objectives contained in the agreement between the Government and SALAR and examine whether they are reasonable and able to be monitored. We are developing the impact targets of the agreement so that we can measure whether or not the overall purposes of the investment are really being achieved. An assessment will then be carried out for each impact target, using the measurements and indicators developed. The objectives of the agreement cover the following areas:

• Data quality
• Open accounting of the results
• Research and innovation
• Patient involvement
• Increased use for operational improvement
• A statistically guaranteed improvement in the quality of healthcare
• The healthcare provided must at least maintain its relative effectiveness internationally
• Coordination of IT
• Patient integrity

In the main evaluation, we will also investigate the extent to which the organisation and efforts are fit for purpose in terms of achieving the targets. This part of the evaluation is qualitative and illustrates the reasons why the measurements and indicators have been developed in the way they have. Main evaluations will be reported in 2014 and 2017.

Block 2: Three in-depth analyses of particularly important development areas 

There are also a number of particularly important strategic issues which the Government and the authorities responsible for healthcare should analyse in more detail in order to ensure that the investment resources – and, by extension, all the resources invested in the registers – are used effectively. The issues relate not only to how the registers can be used to provide added value to the patients today, but also to how the registers can fit in with and contribute to the management and quality assurance of healthcare tomorrow. The three areas in which Vårdanalys considers it necessary to carry out in-depth analyses are as follows:

• Patient benefit: How can the investment encourage the registers to bring the best possible benefit to the interface between the patient and the healthcare service?
• Registers and management: What are the conditions, opportunities and risks of using the registers for the management of healthcare?
• Healthcare data 2.0: What choices of strategic path are being faced by the healthcare services in terms of the development of the information infrastructure, and what is the role of the quality registers in this?

The results from the in-depth analyses will be presented in different publications but will also be included in the evaluation reports in 2014 and 2017.

Block 3: Overall evaluation 

Main evaluations will be published in 2014 and 2017. The 2014 report will contain recommendations on the efforts that will need to be put in place in order to fulfil the aims of the investment. The 2017 report will present an overall evaluation of the benefits of quality registers to the development of healthcare and to the individual patient, based on the main study and the three in-depth analyses of particularly important development areas. In the 2017 report, we will also synthesise the results of the accompanying research projects from the Karolinska Institute, Uppsala University and Jönköping University, as well as other relevant research and development in the area. The 2017 report, with the overall analysis of the investment, will also contain recommendations on strategic development areas and initiatives that will further develop the information infrastructure of the healthcare service.

A TOTAL OF FIVE REPORTS WILL BE PUBLISHED 

Vårdanalys is planning to publish a total of five reports on the investment. In addition to the publications of the main evaluation and the overall evaluation, three reports will also be published on the basis of the in-depth analyses.

2014: Main evaluation

2014: In-depth analysis: Patient benefit

2015: In-depth analysis: The registers and management

2016: In-depth analysis: Healthcare data 2.0

2017: Overall evaluation: A main evaluation, a summary of all the in-depth analyses and a review of the knowledge status (for example, the accompanying research).

The evaluation creates value for several players: 

Vårdanalys’ ambition is for the evaluation of the investment to contribute benefits to a number of the interested parties in the investment. The benefits that we feel the principal interested parties may gain from a broad evaluation of the investment include, among others:

• The patients: The potential of the registers to help to increase the benefits to patients will be realised to a greater extent, while also strengthening patient integrity.
• Authorities responsible for healthcare: Will gain a better foundation for the management and quality assurance of healthcare services.
• The professions: The quality of the registers is enhanced on the basis of the needs of the professions, and that problems with, for example, increased administration and double registration decline.
• The research: A focus on data quality, improved accessibility to data and better reporting of data will help make it easier to perform research on the registers.
• The Government: Will gain a better foundation to make strategic decisions and manage the healthcare services from a national perspective.