- Problem identification and priority setting
- Development of evidence based standards and indicators
- Data collection
- Data analyses, evaluation and interpretation
- Feedback
- Audit
- Implementation of quality improvements
- Public release of data
Priority setting and development:
The diseases are included in NIP on the basis of volume, severity, opportunities for clinical interventions and use of resources. A hearing will be carried out among relevant stakeholders before the final prioritisation.
Development of standards and indicators
When the relevant diseases which are to be monitored have been prioritized, the standards for a good clinical practice and good clinical results are determined. The standards should be based on the scientific literature to assure the highest strength of evidence. If there is no scientific evidence available and the clinical problem in relation to the disease is very important the standards will be determined on the base of consensus among experienced and competent clinical experts. Standards and indicators are determined relating to structure, process and outcome. For each disease about 6-10 indicators are determined.
Structure indicators
Structure indicators assesses the characteristics of the health care system that affect the system's ability to meet the health care needs of individual patients or a community (e.g. the nurse-to-bed ratio in a hospital).
Process indicators
Process indicators assesses what the provider did for the patient and how well he or she did it (e.g. proper diagnostic approach to symptoms).
Outcome indicators
Outcome indicators assesses the influence of the health care delivery process on the individual's health (e.g. morbidity and mortality). The health of the patient in relation to survival, morbidity, the patient's functional status and the psychic reaction to the disease and the satisfaction with the treatment are assessed by the outcome indicators. There is a difference between the intermediary outcome and the final outcome. The intermediary outcome indicators assess the short term outcome while the final outcome indicators assess the long term outcome i.e. whether the patient is cured or relieved from symptoms.
Data collection:
When the standards, indicators and prognostic factors have been determined data collection is initiated. The data from clinical data bases, medical records and central registers are used. The project will so far it is possible use already existing and available data sources e.g. clinical data bases and registers. The collected data are validated in cooperation with clinical epidemiologists.
To secure the comparability of the collected data at hospital unit, hospital, regional and national level, prognostic factors are identified in relation to the defined standards and indicators. These prognostic factors are used as explanation variables and to adjust for case-mix. This is important as it becomes possible to evaluate whether a favourable or unfavourable outcome is due to the health care system or due to conditions the health care system has no influence on, e.g. conditions related to the patient or of the severity disease.
The information is handled confidentially, and the information is analysed in groups of patients. The results that are published are always grouped, so that the identity of the individual patient and the indevidual health care professional can never be recognised.
Data analyses, evaluation and interpretation:
When the data has been collected, analyses, interpretation and evaluation of the results take place. The interpretation takes places nationally, regionally and locally in the different units.
Feedback:
Clinicians and the leaders receive continuous feedback of the results. The hospital units are to know whether they are below or above standard, whether they have been improving or worsening since the last feedback and weather they correspond to the national average.
Audit:
A structured audit process is initiated in order to explain the results. The purpose is to bring forth a specified professional interpretation and to evaluate in relation to critical incidents. The audit process is systematially organised nationally, regionally and locally.
Implementation and public release:
After the described professional process of analyses, interpretation and evaluation according to the audit process the data are publicly released. In relation to this concrete comments from the audit will be presented as well.
