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

Student thesis: Master programme thesis

  • Anja Lundgreen
  • Bjørn Hesselbo
  • Troels Roesbjerg
3 year, Master of Health Informatics (Continuing education) (Continuing Education Programme (Master))
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”.
Publication date2008
Number of pages132
Publishing institutionAalborg universitet
ID: 14372163