Change search
ReferencesLink to record
Permanent link

Direct link
Improved results in paediatric diabetes care using a quality registry in an improvement collaborative: a case study in Sweden
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden.
Department of Pediatric, County Hospital Ryhov, Jönköping, Sweden.
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
Show others and affiliations
2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5(e97875), 1-6 p.Article in journal (Refereed) Published
Abstract [en]


Several studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c) in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures.


Twelve teams at paediatric diabetes centres, caring for 30% (2302/7660) of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients' mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months.


All centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3·7 mmol/mol (p<0.001), compared with non-participating centres who improved their mean HbA1c with 1·7 mmol/mol during the same period. Many of the participating centres reduced the frequency of severe hypoglycaemia and/or ketoacidosis, and five centres reached their goal of ensuring that all patients had some sort of physical activity at least once weekly. Change concepts were, for example, improved guidelines, appointment planning, informing the patients, improving teamwork and active use of the registry, and health promotion activities.


By involving paediatric diabetes teams in a quality improvement collaborative together with access to a quality register, the quality of paediatric diabetes care can improve, thereby contributing to a reduced risk of late complications for children and adolescents with diabetes.

Place, publisher, year, edition, pages
2014. Vol. 9, no 5(e97875), 1-6 p.
National Category
Endocrinology and Diabetes
URN: urn:nbn:se:hj:diva-25619DOI: 10.1371/journal.pone.0097875ISI: 000336914100025PubMedID: 24867418ScopusID: 2-s2.0-84901446997OAI: diva2:779993
Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2016-10-24Bibliographically approved
In thesis
1. Learning and understanding for quality improvement under different conditions: An analysis of quality registry-based collaboratives in acute and chronic care
Open this publication in new window or tab >>Learning and understanding for quality improvement under different conditions: An analysis of quality registry-based collaboratives in acute and chronic care
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The demands that are placed on healthcare systems continue to increase, but several studies show that patient care and healthcare system outcomes are not as good as they could be. To come to terms with these problems, many stakeholders turn to systematic quality improvement methods. However, research and practice also shows that change in organisations is difficult. Consequently many quality improvement projects fail. Quality Improvement Collaboratives (QICs), introduced through the use of the Breakthrough series model, represent a commonly used approach. Despite their widespread application, uncertainty remains regarding the effectiveness of QICs. In Sweden, a number of national quality registries document healthcare actions and outcomes for different patient-groups and problem-areas. While these registries have long been used for follow-up purposes and for clinical research, they have not been used extensively for systematic clinical improvement purposes. The overall aim of this thesis was to examine if, and how, QICs which are supported by national quality registries can contribute to quality improvement in the provision of healthcare. The aim was also to examine what learning and new understanding occurred in the application of QICs in different settings.

The empirical material in this thesis comes from three QICs which included participating teams from different hospitals and health centres in Sweden. Each QIC included a national quality registry: the National Quality Registry for Acute Myocardial Infarction Care (RIKS-HIA); the National Diabetes Registry (NDR); and the Swedish Paediatric Diabetes Quality Registry (SWEDIABKIDS).

The thesis draws on an interactive research approach. The data collection and analysis employed both qualitative and quantitative methods. Data fromthe National Quality Registries, final team reports, focus-group interviews, and team members’ experiences were analysed and triangulated.

The studies shows that QICs which are supported by national quality registries helped teams to close a number of gaps between ordinary clinical practice and evidence-based guidelines, thereby contributing to the provision of better care and better clinical outcomes (Study I, Study II, and Study III). Important factors for success included stakeholders’ learning andunderstanding of the organisational context; structures that supported improvement efforts; and team members’ and managers’ commitment to improvement (Study IV). Furthermore, support by an internal team coach also promoted success (Study IV).

This thesis shows how national quality registries can be used in combination with systematic improvement efforts to produce better clinical results. It concludes that different areas of QIC application pose different challenges; for example, addressing care for acute disease versus chronic disease and evaluating professionally influenced process measures versus patient dependent outcome measures. While different organizational contexts and care characteristics can pose challenges to QIC efforts, the formation of “Communities of Practice” during QICs enhanced the learning for improvement with and from others.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2015. 123 p.
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 65
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
urn:nbn:se:hj:diva-28322 (URN)978-91-85835-64-5 (ISBN)
Public defence
2015-12-18, Originalet, Qulturum, Region Jönköpings län, Jönköping, 13:00 (Swedish)
Available from: 2015-11-16 Created: 2015-11-16 Last updated: 2015-11-20Bibliographically approved

Open Access in DiVA

fulltext(519 kB)34 downloads
File information
File name FULLTEXT02.pdfFile size 519 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Search in DiVA

By author/editor
Peterson, AnetteAndersson-Gäre, Boel
By organisation
The Jönköping Academy for Improvement of Health and WelfareHHJ, Quality Improvement and Leadership in Health and Welfare
In the same journal
Endocrinology and Diabetes

Search outside of DiVA

GoogleGoogle Scholar
Total: 34 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 367 hits
ReferencesLink to record
Permanent link

Direct link