Quality and Efficiency in Swedish Health Care Regional Comparisons 2012 in Swedish Health Care
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Quality and Efficiency Quality and Efficiency in Swedish Health Care Quality and Efficiency in Swedish Health Care in Swedish Health Care Regional Comparisons 2012 Regional Comparisons 2012 Quality and Efficiency in Swedish Health Care Regional Comparisons 2012 Quality and Efficiency in Swedish Health Care – Regional Comparisons 2012 Order or download from Swedish Association of Local Authorities and Regions SE 118 82 Stockholm http://webbutik.skl.se Information: [email protected] ISBN 978-91-7164-949-2 or Swedish National Board of Health and Welfare Publikationsservice Fax: 035-19 75 29 e-mail: [email protected] webshop: www.socialstyrelsen.se/publikationer Art. no 2013-5-7 Swedish Association of Local Authorities and Regions Swedish National Board of Health and Welfare 2013 700 copies Production: Ordförrådet AB Printing: åtta.45, Solna Foreword This is the seventh report of regional comparisons of healthcare quality and ef- ficiency that the Swedish National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions have published jointly. As was the case previously, the primary purpose of the report is to compare counties, although hospital data are frequently presented. The steering committee for the Regional Comparisons 2012 project consisted of Bodil Klintberg and Stefan Ackerby from the Swedish Association of Local Author- ities and Regions, as well as Mona Heurgren and Marie Lawrence from the Swedish National Board of Health and Welfare. The members of the joint task force were Thomas Fröjd, Martin Lindblom and Ka- tarina Wiberg Hedman from the Swedish Association of Local Authorities and Re- gions, as well as Behzad Koucheki, Rickard Ljung and Birgitta Lindelius from the Swedish National Board of Health and Welfare. Anna Sandelin from Registercen- trum in the Västra Götaland region and Fredrik Westander, consultant, also partici- pated in the task force. Soffia Gudbjörnsdottir, Staffan Björck and Göran Garellick from Registercentrum in the Västra Götaland region served as experts. A number of people from both national organisations contributed data for the re- port and its appendices. External sources of data and documentation, particularly national quality registers, were used for a number of indicators. Special thanks go to representatives of the quality registers, as well as others who contributed informa- tion and data to the report. The project was conducted in dialogue with contacts at each of the 21 county councils. Lars-Erik Holm Håkan Sörman Director-General Executive Director Swedish National Board of Swedish Association of Local Health and Welfare Authorities and Regions Summary This is the seventh report in a series entitled Quality and Efficiency in Swedish Health Care – Regional Comparisons. Each report covers a wide range of healthcare areas and presents a large number of indicators and comparisons, generally between the various counties of Sweden. The report provides information and data for use in the public debate about the healthcare system and supports efforts by the county councils to analyse, improve and manage the healthcare services they provide. General observations about changes over time This year’s report presents results for 169 different indicators. The report focuses on national trends for a number of those indicators. While Regional Comparisons is not analytical in nature, the sheer quantity of indicators permits some general observations. National comparison data from a previous period are available for many of the in- dicators. Sixty-one per cent of the indicators show an improvement for women and 71 per cent show an improvement for men. Virtually all of the indicators that reflect survival and mortality reflect a favourable trend. The results are a bit more equivocal when it comes to drugs and medicinal products. The results for some indicators are broken down by the educational level of the patients. Those with the least education have poorer survival rates, higher mortality rates and a greater incidence of avoidable hospitalisation. Another general observation is that gaps in the quality of healthcare services are trending in differ- ent directions depending on whether women or men are considered. Both major and minor differences have emerged. Musculoskeletal conditions – the situation is improving, but not in the entire country The section on musculoskeletal conditions reflects interventions for major groups of diseases: hip fracture and post-fracture osteoporosis, osteoarthritis of the hip and knee, and rheumatoid arthritis that responds to drug therapy. The results for a number of the indicators are either generally good – for example, implant survival (Indicators 59 and 60) or improving over time. The percentage of hip fracture pa- tients receiving arthroplasty (Indicator 66) has increased, while waiting times for surgery have become shorter (Indicator 65). Other areas have seen only modest improvements or none at all. Not enough wom- en with post-fracture osteoporosis receive drug therapy (Indicator 69). Although attention has been called to the indicator for several years, no progress has been identified. Diabetes care – access to data is improving but the results are difficult to interpret In the wake of growing participation in the National Diabetes Register, access to data about the quality of Swedish diabetes care is very good. Most countries can report process indicators only, whereas Sweden is able to monitor fulfilment of a number of key treatment goals. Because reporting and data have become more comprehensive, interpreting trends over time poses a formidable challenge. The percentage of patients achieving the national goals for blood pressure and LDL cho- lesterol (Indicators 81 and 83) has increased, while the percentage achieving glucose control goals has stagnated (Indicator 79). Fewer than half of patients achieve the levels specified in the national guidelines for these three treatment goals. There should be room for improvement, but the percentage of patients who are capable of attaining the treatment goals is difficult to quantify in the absence of formal targets. Cardiac care – greater focus on preventive measures The percentage of patients who die after myocardial infarction is a common quality measure (Indicators 87, 88 and 89). This report reconfirms the long-term decrease in the percentage of patients who die after hospitalisation for myocardial infarc- tion. Waiting times for treatment of ST-segment elevation myocardial infarction and certain other areas of emergency care have potential for improvement, (91). The frequency of restenosis of the coronary artery after percutaneous coronary inter- vention has decreased in recent years (Indicator 96). On another positive note from recent years, heart failure patients are more and more likely to receive the medica- tion recommended in the national guidelines of the Swedish National Board of Health and Welfare (98). Better goal fulfilment in stroke care, but potential for improvement remains Goal fulfilment in stroke care is high for a number of process indicators, including treatment at a special stroke unit and administration of a swallow test (Indicators 103 and 105). The percentage of patients receiving thrombolytic therapy has stead- ily risen, but only a handful of hospitals and counties have reached the level of goal fulfilment specified by the Swedish Stroke Register (Indicator 104). The number of fatalities after stroke has declined over the long term but remained unchanged over the past few years (Indicator 102). The percentage of patients who are independent of others for their personal activities of daily living after stroke has risen somewhat in recent years (Indicator 109). A comparison between hospitals reveals differences in terms of the percentage of fatalities within 90 days after stroke, even after adjustment for age, gender and level of consciousness on arrival (page 232). Cancer care – survival rates still improving Mortality/survival trends for four major types of cancer (Indicators 116, 119, 122, 126) remain favourable over time. Waiting time indicators disclose major differences be- tween the various counties. The median waiting time from receipt of a referral at a specialist clinic until commencement of treatment for malignant head and neck tumours (Indicator 131) was 61 days in 2010/2011, ranging from 37 to 81 days depend- ing on the county. The situation for breast cancer (Indicator 125) is more encourag- ing. The median waiting time between the initial appointment with a specialist and surgery was 21 days in 2011, varying between 13 and 36 days from county to county. Contents Introduction 13 Indicators and Sources of Data 16 Reporting outcomes and interpreting comparisons 20 Overall Indicators 25 MORTALITY, AVOIDABLE HOSPITALISATION, ETC. 1 Life Expectancy..................................................................................................... 26 2 Policy-related Avoidable Mortality ....................................................................... 29 3 Healthcare-related Avoidable Mortality ................................................................. 32 4 Avoidable Deaths from Ischaemic Heart Disease ................................................. 35 5 Suicide among the General Population ................................................................ 38 6 • Ambulance Response Time .................................................................................. 40 7 Avoidable hospitalisation