uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Dahlström, Tobias
Publications (8 of 8) Show all publications
Julin, B., Willers, C., Leksell, J., Lindgren, P., Muth, K. L., Svensson, A.-M., . . . Dahlström, T. (2018). Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden. Diabetes/Metabolism Research Reviews, 34(4), Article ID e2984.
Open this publication in new window or tab >>Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden
Show others...
2018 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 34, no 4, article id e2984Article in journal (Refereed) Published
Abstract [en]

Background: Concurrent multifactorial treatment is needed to reduce consequent risks of diabetes, yet most studies investigating the relationship between sociodemographic factors and health outcomes have focused on only one risk factor at a time. Swedish health care is mainly tax‐funded, thus providing an environment that should facilitate equal health outcomes in patients, independent of background, socioeconomic status, or health profile. This study aimed at investigating the association between several sociodemographic factors and diabetes‐related health outcomes represented by HbA1c, systolic blood pressure, low‐density lipoprotein cholesterol, predicted 5‐year risk of cardiovascular disease, and statin use.

Methods: This large retrospective registry study was based on patient‐level data from individuals diagnosed with type 2 diabetes during 2010 to 2011 (n = 416,228) in any of 7 Swedish regions (~65% of the Swedish population). Health equity in diabetes care analysed through multivariate regression analyses on intermediary outcomes (HbA1c, systolic blood pressure, and low‐density lipoprotein), predicted 5‐year risk of cardiovascular disease and process (i.e., statin use) after 1‐year follow‐up, adjusting for several sociodemographic factors.

Results: We observed differences in intermediary risk measures, predicted 5‐year risk of cardiovascular disease, and process dependent on place of birth, sex, age, education, and social setting, despite Sweden's articulated vision of equal health care.

Conclusions: Diabetes patients' health was associated with sociodemographic prerequisites. Furthermore, in addition to demographics (age and sex) and disease history, educational level, marital status, and region of birth are important factors to consider when benchmarking health outcomes, e.g., average HbA1c level, and evaluating the level of health equity between organizational units or between different administrative regions.

Keywords
type 2 diabetes mellitus, sociodemographics, HbA(1c), systolic blood pressure, statin use, cardiovascular disease
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-356510 (URN)10.1002/dmrr.2984 (DOI)000431984700008 ()29377503 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012/1688
Available from: 2018-08-10 Created: 2018-08-10 Last updated: 2018-08-10Bibliographically approved
Willers, C., Iderberg, H., Axelsen, M., Dahlström, T., Julin, B., Leksell, J., . . . Lilja, M. (2018). Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study. PLoS ONE, 13(6), Article ID e0199170.
Open this publication in new window or tab >>Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study
Show others...
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199170Article in journal (Refereed) Published
Abstract [en]

Background Socioeconomic status, origin or demographic attributes shall not determine the quality of healthcare delivery, according to e.g. United Nations and European Union rules. Health equity has been defined as the absence of systematic disparities and unwarranted differences between groups defined by differences in social advantages. A study was performed to investigate whether this was applicable to type 1 diabetes mellitus (T1D) care in a setting with universal, tax-funded healthcare. Methods This retrospective registry-study was based on patient-level data from individuals diagnosed with T1D during 2010-2011 (n = 16,367) in any of seven Swedish county councils (covering -65% of the Swedish population). Health equity in T1D care was analysed through multivariate regression analyses on absolute HbA1c level at one-year follow-up, one-year change in estimated glomerular filtration rate (eGFR) and one-year change in cardiovascular risk score, using selected sociodemographic dimensions as case-mix factors. Results Higher educational level was consistently associated with lower levels of HbA1c, and so was being married. Never married was associated with worse eGFR development, and lower educational level was associated with higher cardiovascular risk. Women had higher HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25. Conclusion Patients' sociodemographic profile was strongly associated with absolute levels of risk factor control in T1 D, but also with an increased annual deterioration in eGFR. Whether these systematic differences stem from patient-related problems or healthcare organisational shortcomings is a matter for further research. The results, though, highlight the need for intensified diabetes management education and secondary prevention directed towards T1D patients, taking sociodemographic characteristics into account.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Endocrinology and Diabetes Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-360444 (URN)10.1371/journal.pone.0199170 (DOI)000436793500006 ()29958293 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012/1688
Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2018-09-13Bibliographically approved
Fredriksson, M., Halford, C., Eldh, A. C., Dahlström, T., Vengberg, S., Wallin, L. & Winblad, U. (2017). Are data from national quality registries used in quality improvement at Swedish hospital clinics?. International Journal for Quality in Health Care, 29(7), 909-915
Open this publication in new window or tab >>Are data from national quality registries used in quality improvement at Swedish hospital clinics?
Show others...
2017 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, no 7, p. 909-915Article in journal (Refereed) Published
Abstract [en]

To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden. Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level). Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR). Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation. Riksstroke data were reported as most extensively used at individual and unit levels ((x) over bar 17.97 of 24 and (x) over bar 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs ((x) over bar 19.86 for Riksstroke and (x) over bar 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks ((x) over bar 12.90 and (x) over bar 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x<overline> 10.32). In Riksstroke, the managers requested registry data more often ((x) over bar 15.17 of 20). While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation.

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
quality improvement < quality management, audit < external quality assessment, hospital care < setting of care, practice variations < appropriate healthcare, care pathways, disease management < appropriate healthcare, cardiovascular diseases < disease categories, cancers < disease categories, endocrine disorders, incl, diabetes < disease categories
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-339702 (URN)10.1093/intqhc/mzx132 (DOI)000418713200005 ()29077930 (PubMedID)
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-01-26Bibliographically approved
Eldh, A. C., Wallin, L., Fredriksson, M., Vengberg, S., Winblad, U., Halford, C. & Dahlström, T. (2016). Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey. BMJ Open, 6(11), Article ID e011562.
Open this publication in new window or tab >>Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey
Show others...
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 11, article id e011562Article in journal (Refereed) Published
Abstract [en]

Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R-2=0.76) with 'Colleagues' call for local results' (p=<0.001), 'Management Request of Registry data' (p=<0.001), and it was said to be 'Simple to explain the results to colleagues' (p=0.02). Using stepwise regression, 'Colleagues' call for local results' was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-315937 (URN)10.1136/bmjopen-2016-011562 (DOI)000391303400046 ()28128099 (PubMedID)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2017-02-22 Created: 2017-02-22 Last updated: 2018-01-13Bibliographically approved
Eldh, A. C., Fredriksson, M., Vengberg, S., Halford, C., Wallin, L., Dahlström, T. & Winblad, U. (2015). Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden. BMC Health Services Research, 15(1), Article ID 519.
Open this publication in new window or tab >>Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden
Show others...
2015 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, no 1, article id 519Article in journal (Refereed) Published
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-270087 (URN)10.1186/s12913-015-1188-2 (DOI)000365402700001 ()26607344 (PubMedID)
Available from: 2015-12-21 Created: 2015-12-21 Last updated: 2017-12-01Bibliographically approved
Lilja, M., Julin, B., Andersson, G., Andersson, I.-L. -., Axelsen, M., Ek, M., . . . Dahlström, T. (2015). Determinants of HbA(1c) in patients with type 1 diabetes in seven Swedish county councils. Paper presented at 51st Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 14-18, 2015, Stockholm, SWEDEN. Diabetologia, 58(Suppl. 1), S140-S141
Open this publication in new window or tab >>Determinants of HbA(1c) in patients with type 1 diabetes in seven Swedish county councils
Show others...
2015 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 58, no Suppl. 1, p. S140-S141Article in journal, Meeting abstract (Other academic) Published
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-264907 (URN)000359820900279 ()
Conference
51st Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 14-18, 2015, Stockholm, SWEDEN
Note

Meeting Abstract: 278

Available from: 2015-11-04 Created: 2015-10-19 Last updated: 2017-12-01Bibliographically approved
Eldh, A. C., Fredriksson, M., Halford, C., Wallin, L., Dahlström, T., Vengberg, S. & Winblad, U. (2014). Facilitators and barriers to applying a national quality registry for quality improvement in stroke care. BMC Health Services Research, 14, 354
Open this publication in new window or tab >>Facilitators and barriers to applying a national quality registry for quality improvement in stroke care
Show others...
2014 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, p. 354-Article in journal (Refereed) Published
Abstract [en]

Background: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. Methods: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. Results: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. Conclusion: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

Keywords
Evidence based practice, Facilitation, National quality registry, Quality improvement
National Category
Other Health Sciences
Identifiers
urn:nbn:se:uu:diva-232595 (URN)10.1186/1472-6963-14-354 (DOI)000340920400001 ()
Available from: 2014-09-24 Created: 2014-09-22 Last updated: 2017-12-05Bibliographically approved
Fredriksson, M., Eldh, A., Vengberg, S., Dahlström, T., Halford, C., Wallin, L. & Winblad, U. (2014). Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research. Implementation Science, 9(1), 189
Open this publication in new window or tab >>Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research
Show others...
2014 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 9, no 1, p. 189-Article in journal (Refereed) Published
Abstract [en]

Background: Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data.MethodsPoliticians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed.ResultsThe politicians¿ and administrators¿ perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations.ConclusionsThe Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-240439 (URN)10.1186/s13012-014-0189-6 (DOI)000348545500001 ()25544124 (PubMedID)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2015-01-07 Created: 2015-01-07 Last updated: 2017-12-05Bibliographically approved
Organisations

Search in DiVA

Show all publications