151-870 / National clinical quality indicators

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
The Danish Clinical Registries measures the quality of care provided by Danish healthcare institutions to groups of patients with specific medical conditions or patients with undergoing specific procedures or pathways.


Quality indicators
Surveillance of Patient Safety
GOP Description
Implementation level
Clinical settings
The organisation consists of 61 individual clinical registries and 5 supporting institutions. All Danish hospitals and the majority of medical specialities participate. Moreover general practice and primary health care providers are gradually included in data collection and quality improvement activities.
The aim is to create awareness in healthcare professionals about the extent to which the completion and outcomes of the treatment are up to the standards which is expected from a well-functioning healthcare service. At the same time data are used in quality management at institutional, regional and national level.
National population of patients with specific medical conditions or patients undergoing specific interventions.
The initiative focuses on documentation, monitoring and improvement of the quality in health care. The elements included in this are equivalent to steps in the process of quality development in health care:

1.Problem identification and priority setting
2.Development of evidence based standards and indicators
3.Data collection
4.Data analyses, evaluation and interpretation
7.Implementation of quality improvements
8.Public release of data

Timeframe implementation
2-4 years.
Implementation tools available
Please see here for a number of indicator set; http://www.nip.dk/about+the+danish+national+indicator+project/indicator+sets

Please see her for a manual for the Development of Disease-specific Quality Indicators, Standards and Prognostic Factors http://www.nip.dk/files/Subsites/NIP/Engelsk/Developement%20of%20indicators%20in%20DNIP_220510.pdf

Please also see for the same methodology; http://www.qualitymeasures.ahrq.gov/content.aspx?id=39205&search;=copd

Implementation cost
Running costs incl. maintenance and development of registries ; 5 mio. €/per year (national clinical support organisation)
Method used to measure the results
Collection of clinical data for indicator monitoring and auditing of results supported by qualitative (Theory based) evaluation. Please se examples of indicators above.
Please see the following example http://www.nip.dk/files/Subsites/NIP/Publikationer/20090608_%20poster_AN.pdf. The conclusion from the example that by implementing indicators for HF (Heart Failure), focus has increased for the benefit of patients. Indicator results are moving towards better fulfilment, especially manualised education and physical training. The
indicators with no changes can be a result of already good performance. Benchmarking and discussing results by the audit method can raise performance for the benefit of patients.Please also see the references below.
Analysis of the results
Please see her for a manual for the Development of Disease-specific Quality Indicators, Standards and Prognostic Factors http://www.nip.dk/files/Subsites/NIP/Engelsk/Developement%20of%20indicators%20in%20DNIP_220510.pdf

The manual provides a description of how to choose disease categories and the following process with developing the disease-specific quality indicators. The work process for development of indicator
sets in DNIP comprises the following phases:
Phase 0: Itroductory chairpersons ´ meeting
Phase 1: Preparatory chairpersons ´meeting
Phase 2: First meeting of the indicator group
Phase 3: The documentalist’s review and evidence grading of indicators
Phase 4: Second meeting of the indicator group
Phase 5: Finalising of documents to be used
Phase 6: Testing of indicator set and logistics of data collection and data quality audit
Phase 7: Indicator set sent for hearing with external stakeholders
Phase 8: Third meeting of the indicator group
Phase 9: National implementation

When there is developed a set of disease-specific quality indicators there will on an annual basis be publised a report with the results.

Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
1) difficulties in getting uniform clinical buy in of national indicators.

2) difficulties in systematic data collection at clinical level

Describe the strategies used to overcome the barriers (If needed)
Ad. 1) securing clinical ownership by strong linkages to the national medical and nursing societies

Ad 2) constant improvement of feasibility of data collection

Other information
Other information about the GOP that you would like to add (Link or attached document)