Quality and Efficiency in Swedish Health Care

Transkript

1 Quality and Efficiency in Swedish Health Care Regional comparisons 2009 County Council Comparisons Figures of s

2 Introduction Sweden a decentralized health care system In Sweden 21 county councils and regions are responsible for supplying their citizens with health care services. This includes hospital care, primary care, psychiatric care and dental care. Long term care for the elderly is financed and organized by the municipalities. Each county council and region is governed by a political assembly, with its representatives elected for a four year period at every general election. The county councils and regions are of different size., and are considerably larger than the rest, with a population between one and two million each. is smallest, with about inhabitants. Most of the other county councils have populations in the range of inhabitants. Within the framework of national legislation and varying health care policy initiatives from the national government, the county councils and regions have substantial decision-making powers and obligations towards their citizens. The Swedish health care system is, in short, a decentralized system. This makes it natural to put focus on the comparative performance of the county councils and regions. 124 indicators for comparisons of county councils The report Quality and Efficiency in Swedish Healthcare Regional Comparisons have been published since 2006, in yearly reports. This is a shorter, figures-only English version of the fourth report published in November A full, English version of the 2008 report is available for downloading - see below. Here, outcomes are presented for most of the 124 performance indicators which are used to compare the county councils and regions. Figures and indicators for hospitals are excluded. Each indicator is described in the final section of the report. The performance indicators are grouped and presented in the areas shown below. The county councils and regions are ranked, from better outcomes to less good ones, corresponding to the top and the bottom of the figures, respectively. The reader should observe that a good/bad relative outcome, in comparison to other county councils, not without qualifications is a good/bad absolute outcome. All county councils could have top results, for example in an international comparison or vice versa. Variation of outcomes should be interpreted in the light of this observation. For most indicators 95% confidence intervals is used to illustrate statistical uncertainty. There are other sources of uncertainty, some of which are commented in the description of an indicator. The set of indicators is chosen to mirror the health care system as a whole as good as possible, given the obvious and grave restriction of varying data availability and quality. Still, the main evaluative effort is the comparison per each indicator. For a number of reasons we have had no ambition to summarize all indicators and results into an overall ranking of quality and efficiency. 2 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

3 areas Overall s mortality, State of health, etc Preventive measures CONFIDENCE AND PATIENT SATISFACTION Availability Costs s by Area Pregnancy, childbirth and neonatal care Gynaecological Care Musculoskeletal diseases DIABETES CARE Cardiac care stroke care KIDNEY CARE CANCER care PSYCHIATRIC CARE Surgical procedures INTENSIVE CARE DRUG THERAPY OTHER CARE Further material and contact persons This and an earlier report including comments on indicators and outcomes, can be downloaded in PDF format. Download from or from For information about this report and ongoing work in the joint project Quality and Efficiency in Swedish Health Care Regional Comparisons, write to Roger Molin, Swedish Association of Local Authorities and Regions, roger.molin@skl.se Mona Heurgren, Swedish National Board of Health and Welfare, mona.heurgren@socialstyrelsen.se QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

4 Contents Overall s Figure Page of indicator Page mortality, State of health, etc 1 Life expectancy Self-rated general state of health Self-rated psychological well-being Policy-related avoidable mortality 11 5 Healthcare-related avoidable mortality 12 6 Avoidable deaths from ischaemic heart disease Avoidable hospitalisation Targeted screening and contact tracing for Methicillin-resistant Staphylococcus aureus (MRSA) 9 Healthcare related infections Preventive measures 10 Vaccination of children measles-mumps-rubella Influenza vaccination for inhabitants age 65 and older Cervical cancer screening CONFIDENCE AND PATIENT SATISFACTION 14 Access to health care Confidence in care at primary care centres Confidence in hospital care Expected help at visits to primary care or at hospitals Availability 18 Reasonable waiting times for visits at primary care centres Availability of health centres by phone Availability of healthcare advice by phone Appointment with primary care doctor within seven days Waiting times longer than 90 days for appointments with specialists Waiting times longer than 90 days for treatment by specialists Costs 24 Structure-adjusted healthcare costs per capita Cost per DRG point Cost per contact with the primary care system QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

5 s by Area Figure Page of indicator Page Pregnancy, childbirth and neonatal care 27 Induced abortion Foetal mortality Neonatal mortality Percentage of newborns with Apgar score under Third and fourth degree perineal tear during vaginal delivery Caesarian section in uncomplicated pregnancy Gynaecological Care 34 Adverse events after hysterectomy Waiting times longer than 90 days for gynaecological surgery Waiting times longer than 90 days for gynaecological appointments Prolapse of the uterus percentage of day-case surgery Musculoskeletal diseases 39 Total knee arthroplasty implant survival Total hip arthroplasty implant survival Reoperation after total hip arthroplasty Patient-reported outcome of total hip arthroplasty Adverse events after knee and total hip arthroplasty Hip fracture waiting times for surgery Arthroplasty for femur fracture Osteoporosis drugs after fracture Biological drugs for rheumatoid arthritis Patient-reported outcome of treatment for rheumatoid arthritis Waiting times longer than 90 days for orthopaedic visits Waiting times longer than 90 days for hip and knee arthroplasty Knee arthroscopy for osteoarthrosis or degenerative meniscus lesion DIABETES CARE 54 Diabetic patients in primary care who reach the goal for HbA1c levels Diabetic patients in primary care who reach the goal for blood pressure Diabetic patients in primary care who reach the goal for blood lipids levels Lipid lowering drug therapy Child diabetics in primary care who reach the goal for HbA1c levels Amputation above the ankle joint in diabetics QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

6 Figure Page of indicator Page Cardiac care 60 Myocardial infarction 28-day case fatality rate Myocardial infarction 28-day case fatality rate hospitalised patients Recurrence of myocardial infarction Reperfusion therapy for patients with ST-segment elevation myocardial infarction 64 Coronary angiography after non-st-segment elevation myocardial infarction in patients with another risk factor 65 Clopidogrel therapy after non-st-segment elevation myocardial infarction Lipid lowering drug therapy after myocardial infarction Death or readmission after care for heart failure Waiting times for coronary artery surgery Waiting times longer than 90 days for cardiology visits stroke care 71 First-time stroke 28-day case fatality rate Hospitalised first-time stroke 28-day case fatality rate Patients treated at a special stroke unit Thrombolysis treatment after stroke Anticoagulant therapy for stroke patients with atrial fibrillation Readmission for stroke within 365 days Activities of daily living (ADL) ability three months after stroke Satisfaction with stroke care at hospital KIDNEY CARE 79 Survival rate in renal replacement therapy Target fulfilment for dialysis dose Vascular access during dialysis Kidney transplant CANCER care 84 Colon cancer relative five-year survival rates Rectal cancer relative five-year survival rates Breast cancer relative five-year survival rates Lung cancer relative two-year survival rates Reoperation for rectal cancer Prostate cancer curative treatment of patients younger than QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

7 Figure Page of indicator Page PSYCHIATRIC CARE 91 Suicide among the general population Regular treatment with soporifics and sedatives Polypharmacy elderly who consume three or more psychopharmacological drugs 94 Readmission after care for schizophrenia Compliance with lithium therapy for bipolar disorder Waiting times longer than 90 days for visits to child and adolescent psychiatric clinics 97 Waiting times longer than 90 days for visits to adult psychiatric clinics Surgical procedures 98 Reoperation for inguinal hernia Inguinal hernia percentage of day-case operations Minimally invasive cholecystectomy Surgical complications following cholecystectomy Waiting times for operation for symtomatic carotid stenosis Death or amputation after surgery for chronic lower limb ischaemia Patient-reported outcome of septoplasty Cataract surgery, visual acuity below 0.5 in the better seeing eye Waiting times longer than 90 days for general surgery Waiting times longer than 90 days for inguinal hernia surgery Waiting times longer than 90 days for gallbladder/hepatic duct surgery Waiting times longer than 90 days for cataract surgery INTENSIVE CARE 112 Risk-adjusted mortality after treatment at intensive care units Night-time discharge from intensive care units Unscheduled readmission to intensive care units DRUG THERAPY 115 Drug-drug interactions among the elderly Polypharmacy elderly who consume ten or more drugs Occurrence of antibiotic therapy Penicillin V in treatment of children with respiratory antibiotics Quinolone therapy in treatment with urinary tract antibiotics Combination drugs for asthma Percentage of angiotensin II receptor antagonists prescribed for antihypertensive therapy OTHER CARE 122 Good viral control for HIV Assessment of pain intensity at the end of life As-needed prescription of opioids at the end of life QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

8 mortality, state of health, etc Year Figure 1 Women Life expectancy at birth. Children born Source: Population Statistics, Statistics Sweden Year Figure 1 Men Life expectancy at birth. Children born Source: Population Statistics, Statistics Sweden 8 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

9 mortality, state of health, etc Figure 2 Women Percentage of the population that rate their general state of health as good or excellent, Ages Age standardised. Source: Swedish National Institute of Public Health Percent Figure 2 Men Percent Percentage of the population that rate their general state of health as good or excellent, Ages Age standardised. Source: Swedish National Institute of Public Health QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

10 mortality, state of health, etc Figure 3 Women Percentage of the population that rate their psychological well-being as impaired, Ages Age standardised. Source: Swedish National Institute of Public Health Percent Figure 3 Men Percent Percentage of the population that rate their psychological well-being as impaired, Ages Age standardised. Source: Swedish National Institute of Public Health 10 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

11 mortality, state of health, etc Deaths per 000 inhabitants Figure 4 Women Health policy-related avoidable mortality per 000 inhabitants, Ages Age standardised. Source: Cause of Death Register, National Board of Health and Welfare Deaths per 000 inhabitants Figure 4 Men Health policy-related avoidable mortality per 000 inhabitants, Ages Age standardised. Source: Cause of Death Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

12 mortality, state of health, etc RIKET Deaths per 000 inhabitants Figure 5 Women Health care-related avoidable mortality per 000 inhabitants, Ages Age standardised. Source: Cause of Death Register, National Board of Health and Welfare RIKET Deaths per 000 inhabitants Figure 5 Men Health care-related avoidable mortality per 000 inhabitants, Ages Age standardised. Source: Cause of Death Register, National Board of Health and Welfare 12 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

13 mortality, state of health, etc Deaths per 000 inhabitants Figure 6 Women Avoidable deaths from ischaemic heart disease per 000 inhabitants. Ages 1 79, Age standardised. Source: Cause of Death Register, National Board of Health and Welfare Deaths per 000 inhabitants Figure 6 Men Avoidable deaths from ischaemic heart disease per 000 inhabitants. Ages 1 79, Age standardised. Source: Cause of Death Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

14 mortality, state of health, etc Cases per 000 inhabitants Figure 7 Women Patients with avoidable hospitalisations per 000 inhabitants, Age standardised. Source: National Patient Register, National Board of Health and Welfare Cases per 000 inhabitants Figure 7 Men Patients with avoidable hospitalisations per 000 inhabitants, Age standardised. Source: National Patient Register, National Board of Health and Welfare 14 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

15 mortality, state of health, etc Number of cases Percent Figure 8 Percentage of domestically acquired MRSA cases that are detected by means of targeted screening or contact tracing, Source: Swedish Institute for Infectious Disease Control November 2008 Percent Figure 9 Healthcare-associated infections, April Percent of all patients in inpatient care. Source: Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

16 preventive measures Percent Figure 10 Vaccination of children measles-mumps-rubella (MMR) Children born 2006, vaccination status reported in January Source: Swedish Institute for Infectious Disease Control No data available 2007/2008 Percent Figure 11 Influenza vaccination for inhabitants age 65 and older, winter 2008/2009. Source: Infectious Disease Control Units in County Councils 16 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

17 preventive measures Percent Figure 12 Women Percentage of women age who have been screened for cervical cancer, Weighted average. Source: National Quality Register for Cervical Cancer Screening Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

18 confidence and patient satisfaction Did not participate Percent Figure 14 Percentage of the general population reporting that they have access to the health care they need, Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions Did not participate Percent Figure 15 Percentage of the general population with high or very high confidence in primary care, Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions 18 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

19 confidence and patient satisfaction Did not participate Percent Figure 16 Percentage of the general population who report having high or very high confidence in hospital care, Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions Did not participate Percent Figure 17 Percentage of patients who feel that they received the help they expected at their visit, Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

20 availability 1 Figure Did not participate Percent Percentage of patients who feel that waiting-time to visit in primary care centre was acceptable, Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions Did not participate Percent Figure 19 Percentage of patients who feel that it was easy or very easy to reach primary care centres by telephone, Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions 20 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

21 availability Did not participate Percent Figure 20 Percentage of patients who feel that it was easy or very easy to reach the center for health care advice by telephone, Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions Percent Response rate Figure 21 Percentage of patients who were given a doctor's appointment in primary care within seven days, 30 April Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

22 availability October 2008 Response rate Percent Figure 22 Percentage of patients with waiting times longer than 90 days of all on the waiting list specialist appointment, 30 April Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions Response rate October 2008 Percent Figure 23 Percentage of patients with waiting times longer than 90 days of all on the waiting list specialist treatment, 30 April Swedish Association of Local Authorities and Regions 22 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

23 costs (price level of 2008) SEK Figure 24 Structure-adjusted healthcare costs per capita, Source: Swedish Association of Local Authorities and Regions (price level of 2008) SEK Figure 25 Cost per DRG point specialised somatic care, Source: National Patient Register, National Board of Health and Welfare, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

24 costs (price level of 2008) SEK Figure 26 Cost per contact in primary care, Source: Swedish Association of Local Authorities and Regions 24 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

25 pregnancy, childbirth and neonatal care Medical abortions Surgical abortions Percent Figure 27 Women Percentage of abortions prior to the 10 th week of pregnancy, Age standardised. Source: Abortion statistics, National Board of Health and Welfare Cases per births Figure 28 Foetal mortality rate per births Age standardised. Source: Medical Birth Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

26 pregnancy, childbirth and neonatal care Cases per 0 live births Figure 29 Neonatal mortality infants dead within 28 days per live births, Age standardised. Source: Medical Birth Register, National Board of Health and Welfare ,0 0,5 1,0 1,5 2, Percent Figure 30 Percentage of newborns with Apgar score under 7 at five minutes, Age standardised. Source: Medical Birth Register, National Board of Health and Welfare 26 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

27 pregnancy, childbirth and neonatal care Percent Figure 31 Women Percentage of third and fourth degree perineal tear during vaginal delivery, Age standardised. Source: Medical Birth Register, National Board of Health and Welfare Uncomplicated pregnancy Single births among primaparas, ages Percent Figure 32 Women Caesarian section in uncomplicated pregnancy and in all single births among primaparas, Ages Source: Medical Birth Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

28 gynaecological care Percent Figure 34 Women Adverse events after hysterectomy, Ages Age standardised. Source: National Patient Register, National Board of Health and Welfare Response rate October 2008 Percent Figure 35 Women Operation for hysterectomy, prolapse of the uterus and incontinence percentage of patients with waiting times longer than 90 days of all on the waiting list, 30 April Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions 28 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

29 gynaecological care October 2008 Response rate Percent Figure 36 Women Gynaecological outpatient visit percentage of patients with waiting times longer than 90 days of all on the waiting list, 30 April Source: National database on Waiting Times, Swedish Association of Local Authorities and Regions Percent Figure 37 Women Prolapse of the uterus percentage of day-case surgery, Source: National Patient Register, National Board of Health and Welfare. QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

30 musculoskeletal diseases Percent Figure 39 Women Total knee arthroplasty 10-year implant survival, Source: Swedish Knee Arthroplasty Register Percent Figure 39 Men Total knee arthroplasty 10-year implant survival, Source: Swedish Knee Arthroplasty Register 30 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

31 musculoskeletal diseases Percent Figure 40 Women Total hip arthroplasty 10-year implant survival, Source: Swedish Hip Arthroplasty Register Percent Figure 40 Men Total hip arthroplasty 10-year implant survival, Source: Swedish Hip Arthroplasty Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

32 musculoskeletal diseases Percent Figure 41 Reoperation within 2 years after total hip arthroplasty, Source: Swedish Hip Arthroplasty Register 32 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

33 musculoskeletal diseases Index Figure 42 Women Patient-reported outcome after total hip arthroplasty, Improvement in EQ5D after one year. Source: Swedish Hip Arthroplasty Register Index Figure 42 Men Patient-reported outcome after total hip arthroplasty, Improvement in EQ5D after one year. Source: Swedish Hip Arthroplasty Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

34 musculoskeletal diseases Percent Figure 43 Adverse events within 30 days after knee and total hip arthroplasty, Age standardised. Source: National Patient Register, National Board of Health and Welfare No data available 2007 Hours Figure 44 Waiting times for hip fracture surgery after arrival at hospital, Source: National Hip Fracture Registry 34 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

35 musculoskeletal diseases Percent Figure 45 Women Percentage of femur fracture patients 65 years and older who undergo arthroplasty, Age standardised. Source: National Patient Register, National Board of Health and Welfare Percent Figure 45 Men Percentage of femur fracture patients 65 years and older who undergo arthroplasty, Age standardised. Source: National Patient Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

36 musculoskeletal diseases Percent Figure 46 Women Percentage of women age 55 and older with fractures who received osteoporosis drugs within 6 12 months, Age standardised. Source: National Patient Register and the Prescribed Drug Register, National Board of Health and Welfare 36 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

37 musculoskeletal diseases Cases per 000 inhabitants Figure 47 Women Patients treated with biological drugs for rheumatoid arthritis per 000 inhabitants, 1 January Age 18 and older. Source: Swedish Rheumatology Register Cases per 000 inhabitants Figure 47 Men Patients treated with biological drugs for rheumatoid arthritis per 000 inhabitants, 1 January Age 18 and older. Source: Swedish Rheumatology Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

38 musculoskeletal diseases Number of patients Less than 10 cases No data available Percent Figure 48 Rheumatoid arthritis patient reported health improvement six months after commencement of treatment, Source: Swedish Rheumatology Register October 2008 Response rate Percent Figure 49 Orthopedic outpatient visit percentage of patients with waiting times longer than 90 days of all on the waiting list, 30 April Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions 38 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

39 musculoskeletal diseases Oktober 2008 Response rate Percent Figure 50 Hip- and knee replacement percentage of patients with waiting times longer than 90 days of all on the waiting list, 30 April Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

40 musculoskeletal diseases Figure 51 Women Cases per 000 inhabitants Knee arthroscopy in patients with osteoarthritis or degenerative meniscus leison per 000 inhabitants, Patients 40 years and older. Age standardised. Source: National Patient Register, National Board of Health and Welfare Figure 51 Men Cases per 000 inhabitants Knee arthroscopy in patients with osteoarthritis or degenerative meniscus leison per 000 inhabitants, Patients 40 years and older. Age standardised. Source: National Patient Register, National Board of Health and Welfare 40 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

41 diabetes care Level of participation in the register, % Percent Figure 54 Women Percentage of diabetic patients in primary care who reach the goal for HbA1c (<=6.0), Age years. Source: Swedish National Diabetes Register Level of participation in the register, % Percent Figure 54 Men Percentage of diabetic patients in primary care who reach the goal for HbA1c (<=6.0), Age years. Source: Swedish National Diabetes Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

42 diabetes care Level of participation in the register, % Percent Figure 55 Women Percentage of diabetic patients in primary care who reach the blood pressure goal (<=130/80), Age years. Source: Swedish National Diabetes Register Level of participation in the register, % Percent Figure 55 Men Percentage of diabetic patients in primary care who reach the blood pressure goal (<=130/80), Age years. Source: Swedish National Diabetes Register 42 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

43 diabetes care Level of participation in the register, % Percent Figure 56 Women Percentage of diabetic patients in primary care who reach the blood lipids goal (<4,5 mmol/l), Age years. Source: Swedish National Diabetes Register Level of participation in the register, % Percent Figure 56 Men Percentage of diabetic patients in primary care who reach the blood lipids goal (<4,5 mmol/l), Age years. Source: Swedish National Diabetes Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

44 diabetes care July 2005 June 2006 Percent Figure 57 Women Percentage of diabetics receiving diabetes drug therapy who had lipid lowering drugs, July 2008 June Age 40 years and older. Age standardised. Source: Prescribed Drug Register, National Board of Health and Welfare July 2005 June 2006 Percent Figure 57 Men Percentage of diabetics receiving diabetes drug therapy who had lipid lowering drugs, July 2008 June Age 40 years and older. Age standardised. Source: Prescribed Drug Register, National Board of Health and Welfare 44 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

45 diabetes care Percent Figure 58 Percentage of child and adolescent diabetics who reach the goal for HbA1c ( 6,5 %), Age 18 years and younger. Source: Swedish National Diabetes Register Cases per patients Figure 59 Number of first time major amputations in patients with diabetes, Drug treated patients, 60 years and older. Age standardised. Source: National Patient Register and Prescribed Drug Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

46 cardiac care Deaths without hospital care Deaths within 28 days Percent Figure 60 Women 28-day case fatality rate for myocardial infarction, Both hospitalised patients and those who died without being hospitalised. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare Deaths without hospital care Deaths within 28 days Percent Figure 60 Men 28-day case fatality rate for myocardial infarction, Both hospitalised patients and those who died without being hospitalised. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare 46 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

47 cardiac care Preliminary data Percent Figure 61 Women 28-day case fatality rate for myocardial infarction, Hospitalised patients. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare Preliminary data Percent Figure 61 Men 28-day case fatality rate for myocardial infarction, Hospitalised patients. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

48 cardiac care Figure 62 Women Percent Percentage of patients with first-time myocardial infarction that recurs within 365 days, Both hospitalised patients and death in infarction outside hospitals. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare Figure 62 Men Percent Percentage of patients with first-time myocardial infarction that recurs within 365 days, Both hospitalised patients and death in infarction outside hospitals. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare 48 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

49 cardiac care Percentage treated according to target Less than 10 patients PCI, CABG Thrombolysis 2006 Percent Figure 63 Women Reperfusion therapy for patients with ST-segment elevation myocardial infarction, Patients younger than 80. Source: SWEDEHEART Percentage treated according to target PCI, CABG Thrombolysis 2006 Percent Figure 63 Men Reperfusion therapy for patients with ST-segment elevation myocardial infarction, Patients younger than 80. Source: SWEDEHEART QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

50 cardiac care Percent Figure 64 Women Coronary angiography after non-st-segment elevation myocardial infarction and another risk factor, Patients younger than 80. Source: SWEDEHEART Percent Figure 64 Men Coronary angiography after non-st-segment elevation myocardial infarction and another risk factor, Patients younger than 80. Source: SWEDEHEART 50 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

51 cardiac care Percent Figure 65 Women Clopidogrel therapy after non-st-segment elevation myocardial infarction, Patients younger than 80. Source: SWEDEHEART Percent Figure 65 Men Clopidogrel therapy after non-st-segment elevation myocardial infarction, Patients younger than 80. Source: SWEDEHEART QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

52 cardiac care Percent Figure 66 Women Lipid lowering drug therapy months after myocardial infarction, Patients aged Age standardised. Source: National Patient Register and Prescribed Drug Register, National Board of Health and Welfare Percent Figure 66 Men Lipid lowering drug therapy months after myocardial infarction, Patients aged Age standardised. Source: National Patient Register and Prescribed Drug Register, National Board of Health and Welfare 52 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

53 cardiac care Percent Figure 67 Women Readmission for heart failure or death within 30 days for patients hospitalised for heart failure, Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare Percent Diagram 67 Men Readmission for heart failure or death within 30 days for patients hospitalised for heart failure, Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

54 cardiac care Number of cases Less than 10 patients 2007 Days Figure 68 Women Median waiting time between decision to operate and performance of coronary artery bypass graft, Source: SWEDEHEART Number of cases Days Figure 68 Men Median waiting time between decision to operate and performance of coronary artery bypass graft, Source: SWEDEHEART 54 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

55 cardiac care Response rate No data available October 2008 Percent Figure 69 Cardiology outpatient visit percentage of patients with waiting times longer than 90 days of all on the waiting list, 30 April, Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

56 stroke care days 90 days Percent Figure 71 Women 28-day case fatality rate for first-ever stroke, Both hospitalised patients and those who died without being hospitalised. Source: Patient Register and Cause of Death Register, National Board of Health and Welfare days 90 days Percent Figure 71 Men 28-day case fatality rate for first-ever stroke, Both hospitalised patients and those who died without being hospitalised. Source: Patient Register and Cause of Death Register, National Board of Health and Welfare 56 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

57 stroke care days 90 days Percent Figure 72 Women 28-day case fatality rate for first-ever stroke, Hospitalised patients. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare days 90 days Percent Figure 72 Men 28-day case fatality rate for first-ever stroke, Hospitalised patients. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

58 stroke care Completeness compared to National Patient Register Percent Figure 73 Women Percentage of stroke patients treated at a special stroke unit, Source: Swedish Stroke Register Completeness compared to National Patient Register Percent Figure 73 Men Percentage of stroke patients treated at a special stroke unit, Source: Swedish Stroke Register 58 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009

59 stroke care Number of treated patients Percent Figure 74 Percentage of eligible stroke patients who receive thrombolytic therapy, Source: Swedish Stroke Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE

60 stroke care Less than 10 patients Percent Figure 75 Women Anticoagulant therapy after months for stroke patients with atrial fibrillation, Age Age standardised. Source: National Patient Register and Prescribed Drug Register, National Board of Health and Welfare Less than 10 patients Percent Figure 75 Men Anticoagulant therapy after months for stroke patients with atrial fibrillation, Age Age standardised. Source: National Patient Register and Prescribed Drug Register. National Board of Health and Welfare 60 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009