Continuous innovation: developing and using a clinical database with new technology for patient-centred care--the case of the Swedish quality register for arthritis.
OBJECTIVE
We describe and explain the development of a clinical quality database and its use for different clinical, management and patient empowerment purposes.


METHODS
A longitudinal case study covering 1993-2009.


METHODS
Rheumatology departments in Swedish hospitals.


METHODS
Those involved in developing the clinical database and its applications and a limited number of users.


METHODS
Different methods for inputting and storing clinical and patient data and for analysing and presenting the data to providers and patients.


METHODS
Participants' perceptions of the value of different applications and of influences, which helped and hindered the development of the system.


RESULTS
Different innovations were introduced at different times continually to increase the ultility of the clinical data and the clinic- and patient coverage of the clinical data system. Limited interview data show postive patient and provider perceptions of the latest application to collect and present data as time trend visual display in the clinical consultation.


CONCLUSIONS
A longitudinal perspective revealed how a clinical quality register was developed and how new technologies not imagined in the early 1990s continue to increase the ultility and value of the clinical database. This historical perspective provided limited evidence of impact, but does provide lessons for current strategies for innovation for quality in health care and of the need to consider innovolution processes, rather than discrete innovations, given the rapid pace of change in new technologies. More evidence is needed of the impact of such registers, and of enhancements, on providers and patients and on costs.
Medical Management Centre (MMC), Karolinska Institutet, Floor 5, Berzelius väg 3, SE-171 77 Stockholm, Sweden. jovret@aol.com
John
J
Ovretveit
Christina
C
Keller
Helena
H
Hvitfeldt Forsberg
Anna
A
Essén
Staffan
S
Lindblad
Mats
M
Brommels
D001168:Arthritis / Q000188:drug therapy*; D016208:Databases, Factual; D004059:Diffusion of Innovation; D006801:Humans; D008137:Longitudinal Studies; D010353:Patient Education as Topic / Q000379:methods; D018802:Patient-Centered Care; D011209:Power, Psychological; D036301:Qualitative Research; D011787:Quality of Health Care; D012042:Registries; D013548:Sweden; D016896:Treatment Outcome