Center for Clinical Documentation and Evaluation

• Part of Nothern Norway Health trust
• National competence centre for medical quality registries
• People: wide range of professions
• National tasks: distributed organization

• Advisor at CCDE since 2010
• Spent a few years as a software programmer
• Trained marine zoologist
• Very litle knowledge of nutrition…
• Enjoy running, alot

MQR contians a limited set of variables suitable for measuring quality of a given treatment

Reported by the patient

• Patient Reported Outcome Measures (PROM, e.g. pain, mobility, sexual functioning)
• Patient Reported Experience Measures (PREM, e.g. usability, satisfaction)

Reported by the health care workers

• Treatment according to guidelines?
• Inpatient period
• Infection?
• Re-operation?

Other sources

• Mortality (e.g. 30 days)

• Gender
• Age
• Socioeconomic status (income, education, occupation)
• Comorbidity

• Relevant (clinical) varaibles are not found in the health record or other existing registries
• Data must be collected from multiple hospitals/organizations
• Need for PROM/PREM data
• Provide focus on improvements on a speciffic topic

Private link:
http://test.helseregister.no/norgast/

Private link:
http://test.helseregister.no/

Health care workers

• are (in addition to patients) the primary source for data to MQR
• are the primary target of MQR results and "doers" with regard quality improvements
• treat patients INDIVIDUALLY

MQR

• MQR "treat" GROUPS of patients, providing STATISTICS
• MQR does not provide quality improvements, buth rather fundamental data and analysis (documentation) to be used in quality improvement projects
• Actual improvement of health care quality is probably the hardest part of the job…

• Assessment of quality cannot be inferred from single observations
• Measures (of quality) must be based upon a sufficient number of observations
• Multiple factors (both known and unknown) are likely to bias measurements. Sometimes, these can be adjusted for.
• Great care must be taken when interpreting and presenting results

##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max. 
##     1.0     3.4     4.2     4.0     4.7     6.3

##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max. 
##     2.5     3.9     4.4     4.4     5.1     7.2

## 
##  Welch Two Sample t-test
## 
## data:  d1 and d2
## t = -2.5831, df = 150.883, p-value = 0.01074
## alternative hypothesis: true difference in means is not equal to 0
## 95 percent confidence interval:
##  -0.66427812 -0.08849165
## sample estimates:
## mean of x mean of y 
##  4.038581  4.414966

http://www.kvalitetsregistre.no/

http://sundhedsstyrelsen.dk/

http://www.kvalitetsregister.se/

???

• Quality assessemnt must be based on "scientiffic" methods
• MQRs are excellent data sources for research projects
• However, legal regulation can be quite different between quality assessment and research

Enjoy your stay at Sommarøy!