The Finnish Parliament has granted THL a funding of EUR 1.5 million to promote the development of healthcare quality registers. This highlights the potential clinical quality registers have in healthcare.
Medaffcon met with Pia Maria Jonsson, Chief Adviser in the Reforms Unit of the National Institute for Health and Welfare (THL) and Project Leader of the National Healthcare Quality Registers. Read below her thoughts on quality registers and their role in advancing better healthcare by facilitating the improvement of treatment practices and treatment outcomes.
Development of healthcare quality registers provide tools to improve healthcare
“The development of healthcare quality registers is considered necessary primarily because we have such a large social sector utilising extensive resources but lacking essential tools for quality monitoring and quality improvement”, Pia Maria Jonsson explains.
“Currently, social and healthcare (sote) reform also impacts the need. We discuss a lot the impact of sote reform on economy and simultaneously understand that we also need to assess its impacts on the contents, quality and effectiveness of treatment. In addition, the freedom of choice debate often urges that we should have comparative data to inform patients and citizens. In fact, healthcare professionals also need to know where quality is highest or how the quality of treatment is at their clinic when compared to other clinics.”
THL’s role in promoting development of quality registers
“In the ongoing project during 2018–2019, the aim is to create a model or a national concept in the framework of which quality registers work and how the quality register system could be developed. One aim is to launch, in certain clinical fields, projects in which one can develop different aspects of quality register activities, i.e. how data contents are modelled and defined, how technical systems and reporting are developed, and finally, how the obtained new knowledge is utilised in practice.”
Using quality register data for improving quality and effectiveness of treatment practices leads to increased health benefits
“The overall key is that the quality registers aim at optimising the health benefit produced in the healthcare system for patients, at improving their quality of life and in the best case, to cure a disease”, Jonsson summarizes.
“In any case, we strive at ensuring that the patient receiving the treatment feels as good as possible and may possibly have a longer life expectancy. Health benefit can be promoted in many different manners, for example by every clinic and treatment unit following, monitoring and improving quality constantly, and by the register data being used to follow the effectiveness of different methods and technologies used in daily practice. Health benefit can also be promoted with research based on quality register data.”
Development of nationally unified quality registers
“There are already some local and regional quality registers in Finland. Currently, we aim at nationally unified data contents, enabling comparison between units and regions. International comparison of the healthcare quality produced in Finland should become possible. It does not mean that we would like to set up separate registers. Our aim is to create a system, which utilises already recorded data, and creating a data collection in which we can analyse the health benefit produced for the patient and the factors impacting patient’s benefit.”
Monitoring segmented healthcare activities allows comparison between regions and treatment units
“The aim is not to create speciality field specific quality registers, but to be able to follow and improve the treatment of determined patient/disease groups. In quality monitoring, healthcare activities have to be segmented if we want to measure treatment quality and effectiveness properly. The indicators for treatment quality and effectiveness are different in situations where a patient is going through a surgical procedure in speciality healthcare compared to situations where the patients receive medicine-free treatment for diabetes in primary healthcare.”
“We must be able to develop meaningful quality indicators for each patient segment. In quality assessment the most important goal is to learn how our treatment system in total benefits different patients, and whether treatment quality improves or deteriorates.”
Finland could adopt aspects from the Swedish healthcare quality register system
“Upon the time when Sweden and later Denmark and Norway started developing their quality registers, we were in a fairly different situation with regard to the development of data management systems than currently. In Finland, we start now from a better situation since our data management systems have progressed further and we already have some local quality registers, which however work with varying principles. We should now be able to make a joint model and a unified system out of these. With regard to technological solutions and basis of registers’ data management system, our starting point is different, and in this sense, we cannot learn much from other Nordic countries. Instead, we have a lot to learn in terms of the definition of data contents and bringing patients and citizens into this work as well as how data is analysed, how on-going reporting is performed and how we can possibly guide the healthcare activities on these bases, even in economic terms by taking into account treatment quality in the reimbursement methods of producers.”
Roles of the healthcare organizers and producers in developing and maintaining quality registers
“One of the aims of this project is to develop a management model for quality register activities. We see different models in other Nordic countries. Quality register activities can be set by the law, in which case it is obligatory to be part of a register and the health care organiser and producers can cover the main costs of the quality register activities. On the other hand, it can be voluntary to be a participant of a register, in which case the state, for example, can guide register activities by different financial support methods.”
“My view is that the quality register system as well as quality monitoring and quality assurance cannot be separately attached on top of the quality system but instead, it should in principle be an integrated part of treatment production.”
“From this perspective, I find that the financial responsibility is naturally spread between service producers and organising parties, i.e. in the future probably between counties/regions and the state. We do not have, hopefully, any other sector or production that would operate without constant quality assurance and a system designated for this. That is, we consider it rather self-evident that the producer maintains constant quality monitoring and improvement.”
Aiming for centralized data storage systems and avoiding parallel data collections facilitates the use of register data to systematically improve healthcare practices and to promote high-quality research
“The level of the technological development of data management systems and data protection legislation impact on to what extent and with which conditions the data is collected and transferred from one system to another. It is not the aim to make parallel entries. In any case, the principle is that the data is recorded once and usually that is when a healthcare professional meets a patient or customer or a bit afterwards that. It is desirable that the data is transferred into one common data storage or data pool where it can be picked. That is, the quality register is not a separate “box” or a system, but it can be defined as a collection of data that can be used for systematic quality monitoring with unified methods and rules.”
“In practice, the register includes data on patients’ risk factors, prognostic factors, performed diagnostic examinations and provided treatments and above all, treatment results. In this connection, we are not interested in the data of an individual patient, but we need registers in order to compile statistics on the treatment results of large patient groups. We need to be able to analyse these data fluently and in addition, we need to create channels through which the results can be re-entered, for example, for local treatment quality improvement and research use”, Jonsson concludes.