title: Collaboratively Improving Diabetes Care in Sweden Using a National Quality Register: Successes and Challenges-A Case Study.
abstract: BACKGROUND
  Since 1996, the Swedish National Diabetes Register (NDR) enabled health care providers to monitor their clinical performance over time and compare it with the national average. All health systems of Swedish county councils report data. By 2014, the NDR included data from 360 000 patients. Comparisons among county councils show significant variations in clinical outcomes and in adherence to evidence-based national guidelines. The purpose of this study was to evaluate whether and how a quality improvement collaborative could influence clinical practice and outcomes.
  
  
  METHODS
  Twenty-three diabetes teams from all over Sweden, both primary care units and internal medicine departments, joined a quality improvement collaborative. The project was inspired by the Breakthrough Collaborative Model and lasted for 20 months. Evaluation data were collected from the teams' final reports and the NDR throughout the study period.
  
  
  CONCLUSIONS
  The teams reported improved patient outcomes significantly compared with the national average for systolic blood pressure and low-density lipoprotein levels. In contrast, glycated hemoglobin A1c levels deteriorated in the whole NDR population. Five themes of changes in practice were tested and implemented. Success factors included improved teamwork, with active use of register data, and testing new ideas and learning from others.
authors.affiliation: Healthcare Department, Region of Jönköping, Jönköping, Sweden (Ms Peterson and Dr Bojestig); The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden (Ms Peterson and Drs Thor and Andersson-Gäre); Center of Registers in Region Västra Götaland, Gothenburg, Sweden (Dr Gudbjörnsdottir and Ms Löfgren); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg, Sweden (Drs Gudbjörnsdottir); Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Drs Schiöler); and Futurum, Region of Jönköping, Jönköping, Sweden (Dr Andersson Gäre).
authors.forename: Anette
authors.initials: A
authors.lastname: Peterson
authors.forename: Soffia
authors.initials: S
authors.lastname: Gudbjörnsdottir
authors.forename: Ulla-Britt
authors.initials: UB
authors.lastname: Löfgren
authors.forename: Linus
authors.initials: L
authors.lastname: Schiöler
authors.forename: Mats
authors.initials: M
authors.lastname: Bojestig
authors.forename: Johan
authors.initials: J
authors.lastname: Thor
authors.forename: Boel
authors.initials: B
authors.lastname: Andersson Gäre
mesh_terms: D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy*; D019983:Guideline Adherence; D006801:Humans; D058996:Quality Improvement; D012042:Registries; D013548:Sweden