title: Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research.
abstract: BACKGROUND
  Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement's intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data.
  
  
  METHODS
  Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed.
  
  
  RESULTS
  The politicians' and administrators' perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians' role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations.
  
  
  CONCLUSIONS
  The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. mio.fredriksson@pubcare.uu.se.
authors.forename: Mio
authors.initials: M
authors.lastname: Fredriksson
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. anncatrine.eldh@ki.se.|School of Health and Social Science, Dalarna University, 791 88, Falun, Sweden. anncatrine.eldh@ki.se.
authors.forename: Ann Catrine
authors.initials: AC
authors.lastname: Eldh
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. sofie.vengberg@pubcare.uu.se.
authors.forename: Sofie
authors.initials: S
authors.lastname: Vengberg
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. tobias.dahlstrom@ltdalarna.uu.se.
authors.forename: Tobias
authors.initials: T
authors.lastname: Dahlström
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. christina.halford@akademiska.se.
authors.forename: Christina
authors.initials: C
authors.lastname: Halford
authors.affiliation: School of Health and Social Science, Dalarna University, 791 88, Falun, Sweden. lars.wallin@du.se.|Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83, Huddinge, Sweden. lars.wallin@du.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallin
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. ulrika.winblad@pubcare.uu.se.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Winblad
mesh_terms: D000288:Administrative Personnel; D001294:Attitude to Health; D019992:Databases as Topic / Q000592:standards; D055317:Evidence-Based Practice; D006284:Health Plan Implementation; D006801:Humans; D007373:Interinstitutional Relations; D007857:Leadership; D011057:Politics; D058996:Quality Improvement; D012042:Registries / Q000592:standards*; D013548:Sweden