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Open Access Research article

Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

Ann Catrine Eldh12*, Mio Fredriksson1, Christina Halford1, Lars Wallin2, Tobias Dahlström1, Sofie Vengberg1 and Ulrika Winblad1

Author Affiliations

1 Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

2 School of Education, Health, and Social Studies, Dalarna University, SE 791 88 Falun, Sweden

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BMC Health Services Research 2014, 14:354  doi:10.1186/1472-6963-14-354

Published: 27 August 2014

Abstract

Background

National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden.

Methods

A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR’s criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis.

Results

An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data.

Conclusion

While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

Keywords:
Evidence based practice; Facilitation; National quality registry; Quality improvement