Table 3 Examples of strategy components and levels of responsibility

1. Feedback and transparency

Feedback from a trusted source, dissemination of findings to all stakeholders

Embedding CQR reports into health services reporting frameworks, groups of disease-specific registries use consumer-oriented products to share outcome data, direct reporting to government agencies

Benchmarking against best practice, public reporting of data

2. Intervention sustainability

Embedding CQR activities into routine clinical care, adherence to standard care programmes, more regular follow-up of patients, monitoring outcomes and reinstating successful interventions as needed

Integrated administrative and registry databases, individual registry funding through subsidies from pharmaceutical and device manufacturers, dues paid by participating providers and revenues from the sale of registry data and from grants/contracts for studies derived from those data

Guaranteed funding, mandatory participation in CQRs, legal mandate to report specific disease conditions, financial incentives for non-mandatory registries, e.g. payments for clinician participation, registry participation a condition of eligibility for bonus programmes, preferred provider network status and reimbursement

3. Clinical practice guideline adherence

Ongoing monitoring of trusted data, registry verification of adherence to national practice guidelines, patients enrolled in disease-specific management programmes, electronic data systems for decision support, multidisciplinary teams required to justify protocol deviations

Community hospital and academic partnership models identify practice variation to inform strategies to address gaps, regionalisation of specialised services (“hub-and-spoke” model), nonmonetary incentives such as improving patient care

Quality improvement collaboratives

4. Productive partnerships

High levels of participation in registry input

Grant and/or partnership funds from academic institutions, partnerships between professional societies in registry design and implementation

Creation of broad clinician communities of practice, sharing of best practice evidence

5. Whole-of-team approach

Clinician champions; buy-in and interest from managers, physicians and nurses; communication strategies, e.g. registry interest group, calendar of CQR reports, reporting guidelines, templates and dashboard; tying data entry to existing routines; user-friendly technology interface; linking registry quality indicators with QI activities

Local management support for the initiatives, careful registry design to maximise usability and usefulness, use of integrated data for research and clinical practice, e.g. risk calculators

Sustainable funding and support for CQRs, including registry design and development of innovative research methods; improved coordination of national registries and greater dissemination of information on how successful registries operate