Kliniske kvalitetsdatabaser: - af navn eller af gavn?

Abstract

Indledning Politisk er der i Danmark store krav til at forbedre behandlingskvaliteten i sund-hedsvæsenet. De landsdækkende kliniske kvalitetsdatabaser nævnes ofte og i mange strategier som et middel til at nå dette mål. Med dette projekt har vi valgt at undersøge, hvad der begrænser anvendelsen af data fra de kliniske kvalitetsdatabaser til udvikling af den kliniske kvalitet. Vi har samtidigt ville komme med nogle anbefalinger til, hvordan dette kan blive bedre. Metode Vi foretog en indledende undersøgelse på Bispebjerg Hospital, hvor vi interviewede 66 ledere og medarbejdere i 10 sygdomsområder med kliniske kvalitetsdatabaser. Denne undersøgelse bekræftede vores egne erfaringer og vi kunne formulere føl-gende problemformulering: Hvad begrænser anvendelsen af data fra kliniske kvalitetsdatabaser til kvalitetsudvikling og hvordan kan dette ændres? For at undersøge dette nærmere gennemførte vi en audit af indikatorerne i fire ud-valgte sygdomsområder. Vi fulgte op med semistrukturerede interviews med afde-lingsledelser i udvalgte sygdomsområder og med tre nøgleinformanter. Resultater Vi fandt frem til en række barrierer for anvendelse af data til kvalitetsudvikling. De væsentligste var manglende følelse af ejerskab til databaserne, store variationer i den måde databaserne organiseres på, manglende placering af ansvar på flere ni-veauer, indikatorer der ikke er lige velegnede til kvalitetsudvikling og at data gene-relt anvendes mere til at fortælle om produktiviteten. Vi opstillede en række løsningsforslag til, hvordan anvendelsen kan gøre bedre. De væsentligste handler om at se kritisk på organiseringen af databaserne og på de valgte indikatorer, resultater skal efterspørges fra ledelser på alle niveauer og der skal ydes massiv støtte til anvendelsen. Diskussion Projektet viste flere problemstillinger med de kliniske kvalitetsdatabaser. Blandt andet finder vi det relevant, at man i sundhedsvæsenet spørger sig selv om den relativt beskedne kvalitetsudvikling, databaserne medfører, står mål med de mange ressourcer der bruges i arbejdet med de kliniske kvalitetsdatabaser. Projektet tydeliggjorde også, at der blandt de sundhedsprofessionelle i arbejdet med de kliniske kvalitetsdatabaser findes et dilemma, der synes svært at løse. Kli-nikere og ledere efterspørger på samme tid en øget central styring af databaserne, samtidig med, at de ønsker et større ”lokalt ejerskab”.

Introduction At the present time, there is considerable political pressure to improve the quality of treatment in the health service. The nation-wide clinical quality data-bases are often mentioned in connection with the many proposed strategies, as a means of achieving this goal. In this project, we have chosen to investigate which factors limit the use of data from the clinical quality databases in efforts to improve clinical quality. At the same time, we intend to forward some recommenda-tions, as to how this may be achieved. Methods We performed an initial investigation at Bispebjerg Hospital, where we interviewed 66 leaders and staff covering 10 disease areas, where clinical quality databases were in use. These investigations con-firmed our own experiences and lead us to the following problem formulation: Which factors limit the use of data from clinical quality databases in efforts to improve quality and how can this be changed. In order to examine this question more closely, we carried out an audit of indicators in four selected disease areas. We followed this up with semi-structured interviews with department managers in selected disease areas and with three key informants. Results We discovered a series of barriers to the use of data in quality improvement. The most important of these were as follows: a feeling of lack of ownership of the databases; large differences in the manner in which databases were organized; lack of clear placement of responsibility on several levels; the use of indicators, which were not completely suitable to quality devel-opments; and the fact, that databases generally are used more for gathering information about productiv-ity than for quality improvement. We put forward a series of solutions aimed at im-proving the use of the data. The most important of these were suggestions to encourage a more critical approach to the organization of databases and chosen indicators; that results should be requested of man-agement at all levels and that massive support must be given to the use of the databases. Discussion The project demonstrated several problems in the use of clinical quality databases. Amongst others, we find it relevant to suggest, that the health service poses itself the question, whether the relatively small qual-ity improvements, which the use of these databases facilitate can justify the great use of resources in-volved. The project has also underlined a dilemma amongst the health professionals in their work with clinical quality databases, which seems difficult to resolve. Both clinical workers and leaders seek increased central control of the databases, while, at the same time, there is a desire for greater “local ownership”.

A master programme thesis from Aalborg University

Kliniske kvalitetsdatabaser: - af navn eller af gavn?

[High Quality Clinical Databases: - by name or by fact?]