3 Developments in the health care system Shorter admissions increased risk of readmissionsMore patients treated in an outpatient settingRisk of adverse reactions and complications increases with more advanced treatments and changing indicationsA number of readmissions and adverse events are preventableExponentially increasing amounts of data – only used sporadically for monitoring purposes (large data and big data)Patient safety and clinical quality should be monitored locally
5 Strengths of Danish data sources Public health care systemRecord linkage at the individual levelTime and money savingData-collection independent of research questionLarge populations and long-term follow upLiberal data law enabling data accessRelatively inexpensive to get data
7 Clinical Quality Databases (approx. 60 databases – 30MIO DKK) The Danish Registry of Biologic Treatments in RheumatologyThe Danish Colorectal Cancer Group DatabaseThe Danish Stroke RegistryThe Danish Breast Cancer Cooperative Group RegisterThe Danish Transfusion Data BaseThe Danish Registry on Regular Dialysis and TransplantationThe Danish Quality Database for Breast Cancer ScreeningThe Danish Cervix Cancer Screening RegisterThe Danish Hysterectomy DatabaseThe Danish Hip Arthroplasty RegistryThe Danish Knee Arthroplasty RegistryThe Danish Cruciate Ligament RegisterThe Danish Shoulder Alloplasty RegistryThe Danish Urological Cancer Group Database
8 DK Quality of care registries - Mission Improvement: Improving prevention, diagnostics, treatment and rehabilitationManagement/Accountability: Documentation for clinical governance and organisational priority settingTransparency: Information for citizens and patientsInnovation: Research infrastructure
9 Danish Breast Cancer Cooperative Group (DBCG) as an example Established in 1977To standardize treatment and improve breast cancer prognosisData were collected on paper forms until online reporting sinceIncluded originally patients with invasive breast cancer, but now expanded to patients with in situ breast cancer and hereditary breast and ovarian cancer familiesInformation on diagnosis, operation, radiation and medical oncological treatment and follow-upWhen compared with the National Registry of Patients it is estimated that the DBCG lacks about 5% of the total number of women with breast cancer in Denmark – those not included are primarily elderly women
10 The rolls royce model: The National Indicator Project
11 The National Indicator Project (NIP) Established in 1999 in the Danish Healthcare System.A concerted action between a number of Danish institutions, includingthe Ministry of Health,the National Board of Health,the Centre for Evaluation and Assessment of Medical Technology,the Association of Danish Regions,the five regions,the Danish Medical Association,the Scientific Societies,the Danish Nursing Association,the Danish Physiotherapists Associationthe Occupational Therapists Association.
12 National clinical audit Data transmission via InternetCapture of relevant data or direct reporting by responsible cliniciansData analyses by clinical epidemiologistsClinical RegistryReal or virtualClinical activities and data registrationMonthly/quarterly feedback to all clinical departments and MISQuality improvementFeedback of risk adjusted data once a yearPublic releaseNational clinical auditRegional clinical audit
15 CONCLUSIONS:The positive predictive value of acute COPD discharge diagnoses in the Danish National Patient Registry is high (PPV=92%).At the same time, there is a substantial underrecording of COPD during hospitalizations with other acute respiratory disorders like pneumonia and respiratory failure (NPV=81%).
21 Strengths of clinical quality databases as research ressource More detailed clinical data than the central health registriesDefined trajectory for the specific diseaseEasy linkage to national registries via the CPR-number
22 Conclusion: A high pre-diagnostic alcohol seem to have an effect on the course of the disease. This could not be explained by differences in tumor presentation
23 Conclusion: Data do not support the hypothesis that β-blockers attenuate breast cancer recurrence risk
25 Clinical care research Medical Care Variation Research(Comparative) effectiveness researchEvaluation of Quality Improvement Stategies
26 Routine clinical practice Conclusion: approximately 3% experienced VTE, MI, stroke or bleeding. These risks did not decline during the 15-year study period, while the risk of dying fell substantially
27 Routine clinical practice Conclusion: Radiotherapy for breast cancer increased the subsequent rate of ischemic heart disease proportional to the mean radiation dose to the heart. The increase continued for at least 20 years.
30 Quality of early stroke care and hospital costs EvaluationQuality of early stroke care and hospital costsSvendsen ML1,2, Ehlers LH3, Hundborg HH1, Ingeman A1, Johnsen SP11 Department of Clinical Epidemiology, Aarhus University Hospital,Aarhus, Denmark2 Health Technology Assessment & Health Services Research,Public Health and Quality Improvement, Aarhus, Denmark3 Danish Center for Health Care Improvements, Faculty of Social Scienceand Faculty of Health Science, Aalborg University, Aalborg, Denmark
31 RESULTS – PROCESSES RECEIVED (%) AND LOS/COST Processes receivedMean LOS (SD)DaysMean cost USDAdjusted cost difference (95% CI)*0%–24%31.4 (33.4)Reference25%-49%28.8 (33.9))50%-74%24.5 (31.2)75%-100%16.3 (26.1)
32 CONCLUSIONEarly stroke care in agreement with key recommendations for the early management of patients with stroke may be associated with potentially large hospital cost savings
37 PROCRIN – programme for clinical research infrastructure AIM:to strengthen integration among all participating databases, registries, and biobanks in the health care sectorto facilitate data analysisto integrate research findings into daily clinical work, building bridges between research and clinical practice