The quality of care for Swedish patients with acute myocardial infarction (AMI) is continuously increasing. Nevertheless, a great potential for improvement still exists. The aim of the present study was to design and implement a systematic quality improvement (QI) collaborative in the area of AMI care, and to validate its usefulness primarily by analyzing its effect on hospital adherence to national guidelines. Also, the impact on patient morbidity and mortality was to be evaluated. The intervention was based on proven QI methodologies, as well as interactive use of a web-based quality registry with enhanced, powerful feedback functions. 19 hospitals in the intervention group were matched to 19 similar control hospitals. In comparison with the control group, the intervention group showed significantly higher post-interventional improvements in 4 out of 5 analyzed quality indicators (significance shown for ACE-inhibitors, Clopidogrel, Heparin/LMWH, Coronary angiography, no significance for Lipid-lowering therapy). From baseline to the post-intervention measurement, the intervention hospitals showed significantly lower all-cause mortality and cardiovascular re-admission rates (events per 100 patient-years; -2,82, 95% CI -5,26 to -0,39; -9,31, 95% CI -15,48 to -3,14, respectively). No significant improvements were seen in the control group. The improved guideline adherence rates in the intervention hospitals were sustained for all indicators but one (ACE-inhibitors), this during a follow-up measurement three months after study support withdrawal. No effects were seen on any indicators other than those primarily targeted. In conclusion, by combining a systematic QI collaborative with the utilization of a national quality registry, significant improvements in quality of care for patients with AMI can be achieved.

Bakgrund: Senior alert är ett nationellt kvalitetsregister som avser att förebygga trycksår, fall, undernäring, ohälsa i munnen och blåsdysfunktion hos patienter över 65 år. För att identifiera dessa riskområden används olika bedömningsinstrument och sjuksköterskor ansvarar för att registreringarna genomförs och att förebyggande åtgärder sätts in. Syfte: Studiens syfte var att studera sjuksköterskors upplevelse av att arbeta med kvalitetsregistret Senior alert samt hur sjuksköterskorna upplever att arbetet med kvalitetsregistret påverkar vården hos de äldre. Metod: Sex sjuksköterskor verksamma inom Uppsala kommun med erfarenhet av att arbeta med Senior alert intervjuades och en kvalitativ innehållsanalys användes för att bearbeta den insamlade datan.   Resultat: Utifrån den insamlade datan utformades fyra kategorier, Upplevelser av Senior alert som redskap, Senior alert kan förbättras, Tillämpandet av senior alert i praktiken och Arbetet med Senior alert bidrar till ökad vårdprevention och sju underkategorier. Slutsats: Senior alert upplevs som ett bra redskap för att arbeta förebyggande och främja teamarbete, men uppfattas som tidskrävande. Sjuksköterskorna i den här studien anser att vården av de äldre förbättras då identifiering av riskområden sker tidigt och åtgärder sätts in. För att kunna göra resultatet överförbart och veta på vilket sätt vården förbättras behövs ett större urval och frågor som är utformade för att kunna besvara syftet. / Background: Senior Alert is a quality registry which aims to prevent pressure ulcers, falling, malnutrition, bad oral health and urinary incontinence among patients over 65 years. To identify these areas different evaluation tools are used and nurses are responsible for the registrations and making sure preventive actions are made. Aim: The aim of this study was to describe how nurses experience working with the quality registry Senior Alert and how it affects the care of the elderly. Methods: Six nurses working in Uppsala county with experience of working with Senior Alert was interviewed. The interviews were analyzed using a qualitative content analysis. Results: Four categories, Senior Alert as a tool, Senior Alert needs improvement, Working with Senior Alert and Senior Alert contributes to a better health care and seven subcategories were identified. Conclusions: The respondents found Senior Alert to be a helpful tool for preventive work and that it promotes teamwork, but is perceived as time consuming. The nurses in this study think that the care of the elderly improves by early identification and preventive actions, but to do this, study-result transferability and knowing in what way the care will improve it will need a larger target group and more questions to answer the aim of the study.

Today, Real World Data (RWD) is a popular topic in many studies. In particular, it is anticipated to be a significant resource for addressing issues brought on by drug development costs, lengthy development times, and safety concerns. The Swedish healthcare Quality Registries (QR) are studied to contribute to the improvement of health care with individual-based clinical data. Recorded data is used for quality improvement, guidance compliance monitoring, and research. However, the workflow for such a framework that applies RWD which is patient-related data that came from various sources to the new drug development field is currently not well-defined. Thus the main aim of this project is to establish a strategy for integrating RWD with pharmaceutical modeling. To achieve this aim, QRs were examined through an ontological approach. The data and procedures necessary for modeling the development of new drugs, as well as the correspondence of the pieces offered by QR, were studied to assess the feasibility. The modeling of new drug development was studied for three applications: Adverse Drug Event (ADE), Computer-based Simulation (CBS), and drug repurposing, and the analysis of QRs was conducted on seven diseases. After in-depth analysis, although there were differences between the registries, it showed enough feasibility in terms of how much the data provided in the studies on drug repurposing and computer-based simulation satisfied the items required for new drug development. However, in the case of rare diseases, given the lack of an automated method, the ethical ambiguity, and the speed of the process, there still seems to be potential for improvement.  Many registries have begun to support research on the development of novel medications, such as by independently recording the features of drugs. These initiatives could enable the future potential of new Real World Evidence (RWE) such as in the field of proteomics and genomics discovery. / Idag är Real World Data (RWD) ett populärt ämne i många studier. I synnerhet förväntas det vara en betydande resurs för att ta itu med problem som orsakas av kostnader för läkemedelsutveckling, långa utvecklingstider och säkerhetsproblem. Kvalitetsregistren studeras för att bidra till att förbättra hälso- och sjukvården med individbaserade kliniska data. Registrerade data används för kvalitetsförbättring, övervakning av efterlevnad av riktlinjer och forskning. Arbetsflödet för ett sådant ramverk som tillämpar RWD som är patientrelaterad data som kom från olika källor till det nya läkemedelsutvecklingsområdet är dock för närvarande inte väldefinierat. Därför är huvudsyftet med detta projekt att upprätta en strategi för att integrera RWD med läkemedelsmodellering. För att uppnå detta mål undersöktes kvalitetsregister genom ett ontologiskt tillvägagångssätt. De data och procedurer som krävs för att modellera utvecklingen av nya läkemedel, såväl som överensstämmelsen mellan de bitar som erbjuds av kvalitetsregister, studerades för att bedöma genomförbarheten. Modelleringen av utvecklingen av nya läkemedel studerades för tre tillämpningar: skadlig läkemedelseffekt, datorbaserad simulering och återanvändning av läkemedel, och analys av kvalitetsregister genomfördes på sju sjukdomar. Efter en djupgående analys, även om det fanns skillnader mellan registren, visade den tillräcklig genomförbarhet när det gäller hur mycket data som tillhandahållits i studierna om läkemedelsåteranvändning och datorbaserad simulering uppfyllde de krav som krävdes för utveckling av nya läkemedel. Men när det gäller sällsynta sjukdomar, med tanke på avsaknaden av en automatiserad metod, den etiska oklarheten och processens snabbhet, verkar det fortfarande finnas potential för förbättringar. Många register har börjat stödja forskning om utveckling av nya mediciner, till exempel genom att oberoende registrera drogens egenskaper. Dessa initiative skulle kunna möjliggöra den framtida potentialen för nya verkliga bevis, såsom inom området för proteomik och genomik.

<p>Ontology development is a systematic technique to represent the existing and new knowledge about a specific domain by using some models to present the system in which <em>conceptualization</em> is involved. This thesis presents the use of ontologies to formally represent ontology-based competence model for potential users of quality registry report in a healthcare organization. The model describes the professional and occupational interests and needs of the users through structuring and describing their skills and qualifications. There are individual competences model having two main parts: general competence and occupational competence. The model is implemented in an ontology editor. Although our competence model gives the general view about all medical areas in a hospital, from implementation point of view, we have considered only Cardiology area in detail. The potential users of quality registry are medical staff, county council staff and Pharmaceutical staff. In this report we have also used different classifications of education, occupational fields and diseases. A user can get information about the patient and specific disease with treatment tips by using various organizational resources: i.e. quality registries, electronic medical reports, and online journals. Our model also provides a support of information filtering which filters the information according to the need and the competencies of the users.</p>

Ontology development is a systematic technique to represent the existing and new knowledge about a specific domain by using some models to present the system in which conceptualization is involved. This thesis presents the use of ontologies to formally represent ontology-based competence model for potential users of quality registry report in a healthcare organization. The model describes the professional and occupational interests and needs of the users through structuring and describing their skills and qualifications. There are individual competences model having two main parts: general competence and occupational competence. The model is implemented in an ontology editor. Although our competence model gives the general view about all medical areas in a hospital, from implementation point of view, we have considered only Cardiology area in detail. The potential users of quality registry are medical staff, county council staff and Pharmaceutical staff. In this report we have also used different classifications of education, occupational fields and diseases. A user can get information about the patient and specific disease with treatment tips by using various organizational resources: i.e. quality registries, electronic medical reports, and online journals. Our model also provides a support of information filtering which filters the information according to the need and the competencies of the users.