title: Improved results in paediatric diabetes care using a quality registry in an improvement collaborative: a case study in Sweden.
abstract: BACKGROUND
  Several studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c) in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures.
  
  
  METHODS
  Twelve teams at paediatric diabetes centres, caring for 30% (2302/7660) of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients' mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months.
  
  
  RESULTS
  All centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3·7 mmol/mol (p<0.001), compared with non-participating centres who improved their mean HbA1c with 1·7 mmol/mol during the same period. Many of the participating centres reduced the frequency of severe hypoglycaemia and/or ketoacidosis, and five centres reached their goal of ensuring that all patients had some sort of physical activity at least once weekly. Change concepts were, for example, improved guidelines, appointment planning, informing the patients, improving teamwork and active use of the registry, and health promotion activities.
  
  
  CONCLUSIONS
  By involving paediatric diabetes teams in a quality improvement collaborative together with access to a quality register, the quality of paediatric diabetes care can improve, thereby contributing to a reduced risk of late complications for children and adolescents with diabetes.
authors.affiliation: Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden.
authors.forename: Anette
authors.initials: A
authors.lastname: Peterson
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden; Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Hanberger
authors.affiliation: Department of Pediatric, County Hospital Ryhov, Jönköping, Sweden; Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Akesson
authors.affiliation: Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Bojestig
authors.affiliation: Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden.
authors.forename: Boel
authors.initials: B
authors.lastname: Andersson Gäre
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Samuelsson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003922:Diabetes Mellitus, Type 1 / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018802:Patient-Centered Care; D010372:Pediatrics; D011787:Quality of Health Care; D012042:Registries; D013548:Sweden
chemical_list: D006442:Glycated Hemoglobin