Author, location, year | Population, setting, response rate | Intervention/evaluation | Comparator | Outcome: models/methods used | Study design and time frame |
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Ahern, Australia, 2020 [7] | Medical administrators, clinical risk and quality managers, medical heads of departments and principal investigators of clinical registries from the Alfred Hospital, Melbourne | The CQR initiative comprised three main components: (1) ascertaining AH participation in clinical registries, (2) engagement of clinicians in ongoing sharing of CQR outcomes and (3) piloting facilitation of CQR reports into AH clinical governance reporting | N/A | • Established a regular senior clinician Clinical Registry Interest Group as a forum for regular collaboration and discussion • Developed calendar schedule of CQR reports for monitoring by CGU • Incorporated clinical registry site data into existing unit-based safety and quality presentations • Developed guideline requiring units participating in CQRs to provide electronic copy of their reports to the CGU, with a summary of key report findings and action plan, if applicable, on a designated template • Created a CQR traffic-like style dashboard for each registry to allow benchmarked report data to be tracked and visualised over time | Case study of Alfred Health over 18 months (period not stated) |
Algurén, Sweden, 2018 [24] | Clinicians (n = 185; 70% nurses, 26% physicians) via the NQRs’ email networks (121 Swedeheart users and 64 SwedeHF users) | Online survey to determine frequency of NQR use for (a) producing healthcare activity statistics, (b) comparing results between similar departments, (c) sharing results with colleagues, (d) identifying areas for quality improvement (QI), (e) surveilling the impact of QI efforts, (f) monitoring effects of implementation of new treatment methods, (g) doing research and (h) educating and informing healthcare professionals and patients | Clinician use of each registry; physician vs. nurse usage | • Survey of physicians and nurses about how they used data from two registries for nine purposes (see intervention) and how often they did so | A national online survey with users of two NQRs concerning cardiovascular healthcare, conducted between March and May 2016 |
Algurén, Sweden, 2019 [25] | Two quality improvement collaboratives in Sweden. Defined as a structured approach for improvement built on joint learning and with teams from multiple organisations | Final reports of two QICs—one on heart failure care with five teams and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC’s team, were analysed and coded by 18 QIC characteristics and four team characteristics. Routinely collected goal variables from each team within the two registries analysed with univariate statistics | The other QIC. The two QICs differed greatly in design | • Described in detail and compared (a) the components of the respective QIC, (b) the characteristics and activities of each QIC team and (c) the longitudinal outcomes over 3 years after the launch of the QICs • Studied differences between QICs and between the teams and their activities, how they are linked and how they are inter-related with their longitudinal outcomes | Case study with a multiple-case embedded design, e.g. multiple units of analysis (2013–2016) |
Cadilhac, Australia, 2017 [26] | Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack. Fifteen acute care public hospitals in Queensland, Australia | A four-stage, multifaceted organisational intervention including data reviews, education and facilitated action planning. Data on discharge care plan, antihypertensive medication and antiplatelet medication prescription (ischaemic events only) used to select hospitals. Primary measure: composite outcome. Secondary measures: individual adherence changes for each discharge process, sensitivity analyses. Performance outcomes compared 3-months pre-intervention, 3 months post-intervention and at 12 months (sustainability) | The other pilot hospital | • Delivery mechanisms: external facilitation, performance feedback with gap analysis, co-designed educational meeting using a local opinion leader, evidence from exemplar hospitals and structured action planning • Areas for improvement: inconsistent use of existing tools and systems, lack of pharmacist involvement, inconsistent procedural knowledge about discharge planning and suboptimal data recording in AuSCR and med records • Common strategies included providing example of a comprehensive discharge care plan for clinicians to refer to, using reminders (such as stickers in medical records) to facilitate prescription of medications and regular reviews of data at team meetings | A mixed-methods, controlled before-after observational study design |
Cadilhac, Australia, 2019 [27] | 19 of 23 eligible Qld hospitals (83%) and 23 others located elsewhere in Australia. Hospitals all contributed data to AuSCR and previous audits (data from 17,502 patients) | Baseline routine audit and feedback (control phase, 30 months), followed by two interventions: financial incentives (21 months) and the StrokeLink programme involving the addition of externally facilitated quality improvement workshops with action plan development (9 months). Post-intervention phase was 13 months | Historical controls and 23 other Australian hospitals (data from 20,484 patients) | ∘ Financial incentives programme (2012) provided an incentive payment to increase access to stroke. Payments required a minimum proportion of data collected within AuSCR ∘ Enhanced StrokeLink programme: benchmarked feedback to clinicians on hospital performance and action plans to improve care ∘ From 2014, AuSCR clinical indicator and 90-day patient outcome data from the previous 12 months was provided • Other features: interactive discussion on actions to overcome local barriers and the provision of ongoing support via telephone or email | Multicentre, prospective, controlled, before-and-after, quality improvement study, 2010 to 2015 |
Eccleston, Australia, 2017 [28] | 6720 consecutive patients undergoing percutaneous coronary interventions (PCIs) from 10 private hospitals across Australia (Qld, Vic, SA, WA) | Real-time benchmarking via a national clinical quality and outcomes register. GCOR-PCI prospectively collected clinical, procedural, medication and outcomes data from 6720 patients. The main outcome measure was compliance with guideline medications (statins, antiplatelet agents) | Benchmarking of treatment against trial evidence, international guidelines and practice | ∘ Key performance outcomes benchmarked against the aggregated study cohort and international standards ∘ Benchmarked data reported to individual sites ∘ • Included measurement of quality of life at 30 days post-discharge and annually, using EQ-5D (not reported) | Before-and-after study comparing patient data for 2010 and 2014 |
Egholm, Denmark, 2019a [29] | 175 staff in 30 hospital departments participating in the Danish Cardiac Rehabilitation Database Survey response rate was 58% (101/175) | A previously validated, Swedish questionnaire regarding use of data from CQRs was translated and emailed to frontline staff, mid-level managers and heads of departments (n = 175) in all 30 hospitals participating in the Danish Cardiac Rehabilitation Database | N/A | ∘ Used the 50-item quality improvement while adopting quality register outcomes survey (QWAQ) ∘ Measured a range of aspects that may facilitate use of CQR data for QI work, including quality of clinical care, quality of registry data, organisational conditions for registry work and use of data for QI • Data were analysed descriptively and through multiple linear regression | Cross-sectional nationwide survey. Questionnaires emailed in May 2018 |
Egholm, Denmark, 2019b [30] | 24 registry workers (12 each in England and Denmark). Sampled to maximise diversity. Mostly nurses, 23 women | Qualitative interviews with registry workers involved in collecting or entering data into the two registries | England and Denmark | • Content analysis of interviews produced one overarching theme “Struggling with practices” and five categories: the data entry process, registry quality, resources and management support, quality improvement and the wider healthcare context | Interview-based study conducted between Sept 2016 and April 2017 |
Eldh, Sweden, 2016 [31] | Managers, physicians and clinicians in all 72 Swedish stroke units. Response rate: 163/242 individuals (67.4%) from 70 units | A survey including 50 items on context, processes and the registry. Email reminders sent at 2, 3 and 4 weeks. A final reminder was sent after week 5 that included an opportunity to provide reasons for not partaking | N/A | ∘ Survey comprised 50 questions organised in 7 sections: background information about the respondent, quality of care, data quality, organisational conditions, the respondent’s use of registry data, the stroke unit’s use of registry data, and perceived value of the registry • Data analysed descriptively and through multiple linear regression | Survey (distributed Sept. 2014 by email) is second phase in an exploratory sequential design |
Granström, Sweden, 2018 [32] | All existing QRCs (quality registry centres) in Sweden | Document analysis and 25 semi-structured interviews with staff at 6 regional support centres, i.e. (QRCs). Data were analysed using conventional content analysis | Not stated | ∘ Evaluation of how QRC staff understood their mission and role, perceived enablers and barriers for their work and the support strategies they used at each centre ∘ 25 semi-structured interviews were conducted twice with the same individuals (n = 13) ∘ Documents used to complement and contextualise the described strategies and to identify additional important information • Identified strategies mapped according to national or local focus and task- or process-oriented strategies | Multiple case study. Interviews in spring 2014 and 2015 |
Klaiman, USA, 2014 [33] | 12 high-quality registries in the USA, Canada and Sweden, as determined by the research team and an expert panel | Defined characteristics of effectiveness and then studied examples of effective registries in cancer, cardiovascular care, maternity and joint replacement. A preliminary environmental scan identified examples of effective registry design and utilisation in terms of QI, value-based purchasing (VBP) and public reporting | N/A | ∘ Based on results from the environmental scan, in-depth analyses of effective registries were conducted in 4 clinical areas ∘ An analytic framework called “positive defiance” used to understand factors that enable registries to be used successfully for quality monitoring and improvement • In-depth analyses were conducted with staff from 2 to 5 effective registries in each clinical area | Review of effective (positive deviant) registries. Included in-depth interviews with registry staff |
Lipitz-Snyderman, USA, 2019 [34] | 103 clinicians across Memorial Sloan Kettering Cancer Alliance invited to participate. 87 reported participation in a disease management team and were included in final analysis | Survey to physicians treating patients with cancer across the 3 Alliance member health systems, covering: awareness and perceived value of engagement opportunities through MSK Cancer Alliance, which engagement opportunities would they like and has clinical practice changed due to MSK membership. Plus open-ended comments and suggestions | N/A | ∘ MSK Alliance provides opportunities for multidisciplinary clinicians to observe and present cases to MSK tumour boards, connect with MSK physicians for clinical input, attend clinical lectures, participate in MSK disease-specific retreats, provide local access to clinical trials for MSK patients and have MSK physicians participate in local meetings | Online survey. July–Sept. 2017 |
Løwer, Norway, 2013 [35] | Data from patients undergoing six surgical procedures in all hospitals in Norway | ∘ Most Norwegian hospitals use computerised infection control modules (ICMs) to harvest data from the hospitals’ electronic patient admin systems and surgery scheduling systems • ICMs contain de-identified surgical data, module for manual input correction/override, automated generation of patient follow-up letters with bar codes, quality assurance routines and reports statistics generation for local use, quality assurance and submission to national level | Previous rates of surgical site infections | ∘ All Norwegian hospitals participate in the surveillance system with data submitted to Norwegian Institute Public Health ▪ Infections monitored over a 3-month period each year ∘ 3 key features: (1) national and mandatory, (2) highly automated hospital data collection and (3) active post-discharge surveillance ∘ Database used to measure hospital participation, completeness of explanatory variables and post-discharge surveillance • - Data are collected before, during and 30 days after surgery (1 year for implants) and include explanatory and outcome variables; results were presented as proportions | Case study of a surveillance system for surgical site infections, using data from 2005 to 2009 |
Nag, Australia, 2019 [36] | 159 cardiac surgeons from high-performing units invited. 24 (15%) surgeons responded to the initial survey; 20 completed responses were analysed | ∘ 4 Victorian units contributing to the ANZCSTS database invited to participate ∘ Control and intervention groups each included one private and one public unit ∘ Cardiac surgeons surveyed to evaluate current feedback reports and assist in developing content of structured feedback • Intervention units received additional structured feedback | Routine practice. Unit performance also compared to national performance | ∘ Online survey of 159 surgeons contributing data to ANZSCTS ∘ Two control units received current feedback reports, distributed quarterly to the head of unit and data manager ∘ Two intervention units received additional face-to-face structured feedback from an external surgeon at the unit’s quarterly multidisciplinary surgical review meeting ∘ Structured feedback customised to show unit-specific KPIs, highlighting areas of excellence and underperformance. • All participants completed short online study assessment survey | Before-and-after pilot study with online survey followed by targeted intervention in 2 of 4 cardiac units |
Norman, Sweden, 2020 [37] | Use of SwedeHF (Swedish Heart Failure Registry) in one university hospital in one of the three biggest regions in Sweden | ∘ Study of individuals’ decisions after programme focusing on increasing the use of NQRs • SwedeHF chosen because it is relatively new (2003) and less established. The effect of funding from the NQR programme was expected to be more obvious in SwedeHF than in a well-established, long-developed register | N/A | ∘ Four contexts were identified: registration, use of output data, governance and improvement projects ∘ Used realist evaluation to identify contexts, mechanisms and outcomes • Explored different logics or “rules of the game” embedded in unconscious social norms that are part of work | Case study with 18 semi-structured interviews (2013–2015). Representatives from NQR contexts as well as the healthcare contexts were interviewed |