title: Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey.
abstract: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement.
  
  
  
  Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression.
  
  
  
  A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with 'Colleagues' call for local results' (p=<0.001), 'Management Request of Registry data' (p=<0.001), and it was said to be 'Simple to explain the results to colleagues' (p=0.02). Using stepwise regression, 'Colleagues' call for local results' was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results.
  
  
  
  While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.|School of Health and Social Science, Dalarna University, Falun, Sweden.
authors.forename: Ann Catrine
authors.initials: AC
authors.lastname: Eldh
authors.affiliation: School of Health and Social Science, Dalarna University, Falun, Sweden.|Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallin
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Mio
authors.initials: M
authors.lastname: Fredriksson
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Sofie
authors.initials: S
authors.lastname: Vengberg
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Winblad
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Halford
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Dahlström
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D012042:Registries / Q000592:standards*; D020521:Stroke / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT