Quality and Efficiency in Swedish Health Care Regional comparisons 2009 County Council Comparisons Figures of s
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 60 000 inhabitants. Most of the other county councils have populations in the range of 200 300 000 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 2009. 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
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 www.skl.se/compare or from www.socialstyrelsen.se/publicerat 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 2009 3
Contents Overall s Figure Page of indicator Page mortality, State of health, etc 1 Life expectancy 8 99 2 Self-rated general state of health 9 99 3 Self-rated psychological well-being 10 99 4 Policy-related avoidable mortality 11 5 Healthcare-related avoidable mortality 12 6 Avoidable deaths from ischaemic heart disease 13 101 7 Avoidable hospitalisation 14 102 8 Targeted screening and contact tracing for 15 102 Methicillin-resistant Staphylococcus aureus (MRSA) 9 Healthcare related infections 15 103 Preventive measures 10 Vaccination of children measles-mumps-rubella 16 103 11 Influenza vaccination for inhabitants age 65 and older 16 103 12 Cervical cancer screening 17 104 CONFIDENCE AND PATIENT SATISFACTION 14 Access to health care 18 104 15 Confidence in care at primary care centres 18 104 16 Confidence in hospital care 19 105 17 Expected help at visits to primary care or at hospitals 19 105 Availability 18 Reasonable waiting times for visits at primary care centres 20 105 19 Availability of health centres by phone 20 106 20 Availability of healthcare advice by phone 21 106 21 Appointment with primary care doctor within seven days 21 106 22 Waiting times longer than 90 days for appointments with specialists 22 107 23 Waiting times longer than 90 days for treatment by specialists 22 107 Costs 24 Structure-adjusted healthcare costs per capita 23 108 25 Cost per DRG point 23 109 26 Cost per contact with the primary care system 24 109 4 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
s by Area Figure Page of indicator Page Pregnancy, childbirth and neonatal care 27 Induced abortion 25 111 28 Foetal mortality 25 111 29 Neonatal mortality 26 111 30 Percentage of newborns with Apgar score under 7 26 112 31 Third and fourth degree perineal tear during vaginal delivery 27 112 32 Caesarian section in uncomplicated pregnancy 27 112 Gynaecological Care 34 Adverse events after hysterectomy 28 113 35 Waiting times longer than 90 days for gynaecological surgery 28 114 36 Waiting times longer than 90 days for gynaecological appointments 29 114 37 Prolapse of the uterus percentage of day-case surgery 29 114 Musculoskeletal diseases 39 Total knee arthroplasty implant survival 30 114 40 Total hip arthroplasty implant survival 31 115 41 Reoperation after total hip arthroplasty 32 115 42 Patient-reported outcome of total hip arthroplasty 33 115 43 Adverse events after knee and total hip arthroplasty 34 116 44 Hip fracture waiting times for surgery 34 116 45 Arthroplasty for femur fracture 35 117 46 Osteoporosis drugs after fracture 36 117 47 Biological drugs for rheumatoid arthritis 37 118 48 Patient-reported outcome of treatment for rheumatoid arthritis 38 118 49 Waiting times longer than 90 days for orthopaedic visits 38 118 50 Waiting times longer than 90 days for hip and knee arthroplasty 39 118 51 Knee arthroscopy for osteoarthrosis or degenerative meniscus lesion 40 119 DIABETES CARE 54 Diabetic patients in primary care who reach the goal for HbA1c levels 41 119 55 Diabetic patients in primary care who reach the goal for blood pressure 42 120 56 Diabetic patients in primary care who reach the goal for blood lipids levels 43 120 57 Lipid lowering drug therapy 44 120 58 Child diabetics in primary care who reach the goal for HbA1c levels 45 121 59 Amputation above the ankle joint in diabetics 45 121 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 5
Figure Page of indicator Page Cardiac care 60 Myocardial infarction 28-day case fatality rate 46 122 61 Myocardial infarction 28-day case fatality rate hospitalised patients 47 122 62 Recurrence of myocardial infarction 48 123 63 Reperfusion therapy for patients with ST-segment elevation myocardial 49 124 infarction 64 Coronary angiography after non-st-segment elevation myocardial 50 124 infarction in patients with another risk factor 65 Clopidogrel therapy after non-st-segment elevation myocardial infarction 51 125 66 Lipid lowering drug therapy after myocardial infarction 52 125 67 Death or readmission after care for heart failure 53 126 68 Waiting times for coronary artery surgery 54 126 69 Waiting times longer than 90 days for cardiology visits 55 127 stroke care 71 First-time stroke 28-day case fatality rate 56 127 72 Hospitalised first-time stroke 28-day case fatality rate 57 127 73 Patients treated at a special stroke unit 58 128 74 Thrombolysis treatment after stroke 59 128 75 Anticoagulant therapy for stroke patients with atrial fibrillation 60 129 76 Readmission for stroke within 365 days 61 129 77 Activities of daily living (ADL) ability three months after stroke 62 130 78 Satisfaction with stroke care at hospital 63 130 KIDNEY CARE 79 Survival rate in renal replacement therapy 64 131 80 Target fulfilment for dialysis dose 65 131 81 Vascular access during dialysis 66 131 82 Kidney transplant 67 132 CANCER care 84 Colon cancer relative five-year survival rates 68 132 85 Rectal cancer relative five-year survival rates 69 133 86 Breast cancer relative five-year survival rates 70 133 87 Lung cancer relative two-year survival rates 71 134 88 Reoperation for rectal cancer 72 134 89 Prostate cancer curative treatment of patients younger than 70 72 135 6 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
Figure Page of indicator Page PSYCHIATRIC CARE 91 Suicide among the general population 73 135 92 Regular treatment with soporifics and sedatives 74 135 93 Polypharmacy elderly who consume three or more 75 136 psychopharmacological drugs 94 Readmission after care for schizophrenia 76 137 95 Compliance with lithium therapy for bipolar disorder 77 137 96 Waiting times longer than 90 days for visits to child and adolescent 78 137 psychiatric clinics 97 Waiting times longer than 90 days for visits to adult psychiatric clinics 78 137 Surgical procedures 98 Reoperation for inguinal hernia 79 138 99 Inguinal hernia percentage of day-case operations 79 138 Minimally invasive cholecystectomy 80 138 101 Surgical complications following cholecystectomy 81 139 103 Waiting times for operation for symtomatic carotid stenosis 81 139 104 Death or amputation after surgery for chronic lower limb ischaemia 82 139 106 Patient-reported outcome of septoplasty 82 140 107 Cataract surgery, visual acuity below 0.5 in the better seeing eye 83 140 108 Waiting times longer than 90 days for general surgery 83 140 109 Waiting times longer than 90 days for inguinal hernia surgery 84 140 110 Waiting times longer than 90 days for gallbladder/hepatic duct surgery 84 140 111 Waiting times longer than 90 days for cataract surgery 85 141 INTENSIVE CARE 112 Risk-adjusted mortality after treatment at intensive care units 86 141 113 Night-time discharge from intensive care units 87 141 114 Unscheduled readmission to intensive care units 88 142 DRUG THERAPY 115 Drug-drug interactions among the elderly 89 142 116 Polypharmacy elderly who consume ten or more drugs 90 143 117 Occurrence of antibiotic therapy 91 143 118 Penicillin V in treatment of children with respiratory antibiotics 92 144 119 Quinolone therapy in treatment with urinary tract antibiotics 93 144 120 Combination drugs for asthma 94 145 121 Percentage of angiotensin II receptor antagonists prescribed for antihypertensive therapy 95 145 OTHER CARE 122 Good viral control for HIV 96 146 123 Assessment of pain intensity at the end of life 97 146 124 As-needed prescription of opioids at the end of life 98 147 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 7
mortality, state of health, etc 83.9 83.5 83.4 83.2 83.2 83.0 83.0 83.0 83.0 82.9 82.8 82.8 82.8 82.8 82.7 82.6 82.4 82.3 82.3 82.3 82.1 82.0 0 20 40 60 80 2003 2007 Year Figure 1 Women Life expectancy at birth. Children born 2004 2008. Source: Population Statistics, Statistics Sweden 79.7 79.7 79.5 79.2 79.1 79.1 78.9 78.9 78.8 78.8 78.7 78.7 78.6 78.6 78.5 78.3 78.2 78.1 78.0 77.8 77.7 77.6 0 20 40 60 80 2003 2007 Year Figure 1 Men Life expectancy at birth. Children born 2004 2008. Source: Population Statistics, Statistics Sweden 8 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
mortality, state of health, etc Figure 2 Women 73 72 72 70 69 69 69 68 68 68 67 67 67 66 66 66 66 65 65 65 63 62 0 20 40 60 80 Percentage of the population that rate their general state of health as good or excellent, 2006 2009. Ages 16 84. Age standardised. Source: Swedish National Institute of Public Health Percent Figure 2 Men 77 76 76 74 74 74 74 73 73 73 73 72 72 72 71 71 71 71 71 70 70 67 0 20 40 60 80 Percent Percentage of the population that rate their general state of health as good or excellent, 2006 2009. Ages 16 84. Age standardised. Source: Swedish National Institute of Public Health QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 9
mortality, state of health, etc Figure 3 Women 15 16 16 17 17 18 18 19 20 20 20 20 20 20 20 20 21 23 23 24 24 31 0 10 20 30 40 Percentage of the population that rate their psychological well-being as impaired, 2006 2009. Ages 16 84. Age standardised. Source: Swedish National Institute of Public Health Percent Figure 3 Men 10 11 11 12 12 13 13 13 13 14 14 14 14 15 15 15 15 15 15 16 17 18 0 10 20 30 40 Percent Percentage of the population that rate their psychological well-being as impaired, 2006 2009. Ages 16 84. Age standardised. Source: Swedish National Institute of Public Health 10 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
mortality, state of health, etc 23.3 27.1 27.6 30.0 31.2 31.6 31.7 32.1 32.5 32.8 33.5 33.7 33.9 34.5 35.7 36.2 36.4 38.6 38.8 39.8 41.1 43.6 0 20 40 60 80 2000 2003 Deaths per 000 inhabitants Figure 4 Women Health policy-related avoidable mortality per 000 inhabitants, 2004 2007. Ages 1 79. Age standardised. Source: Cause of Death Register, National Board of Health and Welfare 42.1 47.6 48.0 48.2 49.7 50.5 50.7 51.8 52.0 52.5 53.4 55.2 55.7 55.8 56.2 56.3 57.0 57.2 57.2 60.0 60.6 64.9 0 20 40 60 80 2000 2003 Deaths per 000 inhabitants Figure 4 Men Health policy-related avoidable mortality per 000 inhabitants, 2004 2007. Ages 1 79. Age standardised. Source: Cause of Death Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 11
mortality, state of health, etc RIKET 30.8 35.9 36.1 36.5 36.5 36.7 36.8 37.9 38.8 39.0 39.3 39.3 41.1 41.5 42.8 44.7 45.9 46.2 46.4 46.6 47.4 48.0 0 20 40 60 80 2000 2003 Deaths per 000 inhabitants Figure 5 Women Health care-related avoidable mortality per 000 inhabitants, 2004 2007. Ages 1 79. Age standardised. Source: Cause of Death Register, National Board of Health and Welfare RIKET 40.7 45.0 46.2 50.7 53.4 54.3 55.2 55.3 55.9 57.0 58.1 58.5 58.6 60.6 61.2 61.3 62.3 62.4 64.3 70.1 70.9 71.9 0 20 40 60 80 2000 2003 Deaths per 000 inhabitants Figure 5 Men Health care-related avoidable mortality per 000 inhabitants, 2004 2007. Ages 1 79. Age standardised. Source: Cause of Death Register, National Board of Health and Welfare 12 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
mortality, state of health, etc 21.9 26.4 29.5 32.6 35.6 36.1 38.8 39.1 39.6 39.7 40.9 42.1 42.4 42.8 43.3 44.8 45.4 46.2 47.2 47.3 48.3 48.9 0 30 60 90 120 150 2004 2005 Deaths per 000 inhabitants Figure 6 Women Avoidable deaths from ischaemic heart disease per 000 inhabitants. Ages 1 79, 2006 2007. Age standardised. Source: Cause of Death Register, National Board of Health and Welfare 89.3 89.9 91.5 94.7 97.3.0 101.7 103.2 104.3 105.3 106.5 109.0 109.7 109.8 111.3 111.7 116.2 116.7 119.0 122.7 123.8 124.5 0 30 60 90 120 150 2004 2005 Deaths per 000 inhabitants Figure 6 Men Avoidable deaths from ischaemic heart disease per 000 inhabitants. Ages 1 79, 2006 2007. Age standardised. Source: Cause of Death Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 13
mortality, state of health, etc 887 937 941 988 7 1034 1034 1035 1037 1051 1055 1056 1063 1079 1097 1101 1113 1127 1149 1166 1179 1190 0 500 0 1500 2000 2003 Cases per 000 inhabitants Figure 7 Women Patients with avoidable hospitalisations per 000 inhabitants, 2008. Age standardised. Source: National Patient Register, National Board of Health and Welfare 1036 1153 1198 1240 1252 1260 1262 1273 1288 1328 1330 1353 1353 1358 1360 1372 1411 1452 1463 1467 1484 1492 0 500 0 1500 2000 2003 Cases per 000 inhabitants Figure 7 Men Patients with avoidable hospitalisations per 000 inhabitants, 2008. Age standardised. Source: National Patient Register, National Board of Health and Welfare 14 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
mortality, state of health, etc 76.9 75.9 69.2 64.7 63.5 58.9 56.5 56.5 55.9 52.6 52.2 50.0 50.0 50.0 47.6 45.5 41.5 33.3 33.3 31.3 29.2 28.6 Number of cases 26 29 26 17 266 421 69 46 1 415 19 228 30 32 26 21 11 41 24 15 16 24 28 0 20 40 60 80 Percent Figure 8 Percentage of domestically acquired MRSA cases that are detected by means of targeted screening or contact tracing, 2007 2008. Source: Swedish Institute for Infectious Disease Control 6.0 6.4 7.6 7.7 7.7 8.0 8.1 8.4 8.9 9.3 9.3 9.6 9.7 9.8 10.0 10.0 10.1 10.1 10.3 10.7 10.8 11.4 0 3 6 9 12 15 3 16 November 2008 Percent Figure 9 Healthcare-associated infections, 15 30 April 2009. Percent of all patients in inpatient care. Source: Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 15
preventive measures 98.8 98.3 98.3 98.2 98.1 97.9 97.9 97.8 97.6 97.5 97.5 97.4 97.3 97.2 97.1 96.9 96.8 96.8 96.7 96.7 95.2 94.1 0 20 40 60 80 Percent Figure 10 Vaccination of children measles-mumps-rubella (MMR) Children born 2006, vaccination status reported in January 2009. Source: Swedish Institute for Infectious Disease Control 1 1 75.0 73.0 73.0 71.0 69.0 69.0 68.2 68.0 68.0 68.0 65.6 64.0 64.0 64.0 63.0 62.6 60.3 59.0 58.0 56.0 0 20 40 60 80 1 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
preventive measures 92.5 91.5 90.2 89.6 87.2 86.0 85.0 84.5 82.5 81.8 81.2 79.5 78.6 77.4 77.1 77.0 75.9 75.9 74.7 73.4 73.0 69.6 0 20 40 60 80 2004 Percent Figure 12 Women Percentage of women age 23 60 who have been screened for cervical cancer, 2008. Weighted average. Source: National Quality Register for Cervical Cancer Screening Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 17
confidence and patient satisfaction 1 85 82 81 81 80 79 79 78 78 78 78 77 76 75 75 75 75 74 73 69 68 0 20 40 60 80 2006 1 Did not participate Percent Figure 14 Percentage of the general population reporting that they have access to the health care they need, 2008. Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions 1 67 61 60 60 59 58 57 56 56 56 56 56 56 55 55 55 55 53 53 53 51 0 20 40 60 80 1 2006 Did not participate Percent Figure 15 Percentage of the general population with high or very high confidence in primary care, 2008. Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions 18 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
confidence and patient satisfaction 1 75 73 72 72 71 70 70 69 69 68 68 68 68 67 67 67 66 66 64 64 60 0 20 40 60 80 2006 1 Did not participate Percent Figure 16 Percentage of the general population who report having high or very high confidence in hospital care, 2008. Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions 1 89 87 86 86 85 85 85 85 84 84 84 83 83 83 83 83 83 83 83 81 81 0 20 40 60 80 1 2006 Did not participate Percent Figure 17 Percentage of patients who feel that they received the help they expected at their visit, 2008. Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 19
availability 1 Figure 18 92 88 88 87 86 86 86 86 85 85 84 84 83 83 83 81 81 80 79 78 76 0 20 40 60 80 1 2006 Did not participate Percent Percentage of patients who feel that waiting-time to visit in primary care centre was acceptable, 2008. Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions 1 72 67 67 67 66 66 63 63 61 60 59 59 59 57 56 56 53 51 44 40 39 0 20 40 60 80 1 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, 2008. Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions 20 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
availability 78 74 74 73 68 67 66 66 65 64 63 62 61 60 58 57 57 56 55 53 50 0 20 40 60 80 1 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, 2008. Source: Population and Patient Survey, Swedish Association of Local Authorities and Regions 95.5 95.0 93.6 93.0 92.8 92.3 92.3 92.3 92.0 91.2 91.1 90.6 90.3 89.4 88.9 88.7 88.6 88.2 87.6 86.9 85.2 83.1 0 20 40 60 80 Percent Response rate 88 95 98 96 88 98 95 93 90 98 97 87 Figure 21 Percentage of patients who were given a doctor's appointment in primary care within seven days, 30 April 2008. Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 21
availability 5.1 6.3 6.9 11.1 11.2 11.4 13.2 14.7 15.2 17.7 17.8 19.6 20.3 20.4 21.2 23.8 24.2 26.3 30.5 33.7 34.4 39.4 October 2008 Response rate 0 10 20 30 40 50 99 91 98 99 96 96 Percent Figure 22 Percentage of patients with waiting times longer than 90 days of all on the waiting list specialist appointment, 30 April 2009. Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions 2.5 6.7 8.0 8.2 9.9 10.3 12.1 14.5 14.9 17.0 17.2 18.9 19.3 19.8 20.5 20.8 20.8 21.3 25.0 28.3 33.4 43.1 Response rate 98 90 97 92 97 95 92 0 10 20 30 40 50 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 2009. Swedish Association of Local Authorities and Regions 22 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
costs 17 768 18 949 19 060 19 077 19 217 19 322 19 457 19 498 19 774 19 786 19 875 19 974 20 006 20 208 20 269 20 471 20 585 20 621 20 688 20 782 20 966 21 014 0 5 000 10 000 15 000 20 000 25 000 2005 (price level of 2008) SEK Figure 24 Structure-adjusted healthcare costs per capita, 2008. Source: Swedish Association of Local Authorities and Regions 41 111 42 510 43 386 43 749 43 769 43 860 44 028 44 298 44 973 45 022 45 150 45 540 45 598 45 978 46 674 46 682 47 025 47 447 48 395 49 975 50 704 52 712 0 10 000 20 000 30 000 40 000 50 000 60 000 2006 (price level of 2008) SEK Figure 25 Cost per DRG point specialised somatic care, 2008. Source: National Patient Register, National Board of Health and Welfare, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 23
costs 1 132 1 162 1 163 1 166 1 196 1 196 1 204 1 234 1 237 1 256 1 263 1 268 1 280 1 301 1 310 1 339 1 339 1 354 1 380 1 523 1 595 1 642 0 500 1 000 1 500 2 000 2005 (price level of 2008) SEK Figure 26 Cost per contact in primary care, 2008. Source: Swedish Association of Local Authorities and Regions 24 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
pregnancy, childbirth and neonatal care 83.2 81.4 79.9 79.9 79.6 79.3 79.0 78.0 77.3 77.2 76.5 76.3 76.0 75.5 74.9 74.7 73.4 72.8 71.8 71.3 71.0 69.6 0 20 40 60 80 Medical abortions Surgical abortions 2005 2007 Percent Figure 27 Women Percentage of abortions prior to the 10 th week of pregnancy, 2006 2008. Age standardised. Source: Abortion statistics, National Board of Health and Welfare 2.33 2.45 2.50 2.55 2.57 2.69 2.86 2.98 2.99 3.10 3.10 3.12 3.14 3.26 3.36 3.41 3.41 3.53 3.55 3.66 4.15 4.27 0 1 2 3 4 5 6 1998 2002 Cases per 1 000 births Figure 28 Foetal mortality rate per 1 000 births. 2003 2007. Age standardised. Source: Medical Birth Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 25
pregnancy, childbirth and neonatal care 1.41 1.46 1.51 1.58 1.61 1.64 1.64 1.67 1.73 1.78 1.83 1.84 1.89 1.95 2.15 2.16 2.22 2.61 2.77 2.82 3.04 3.24 0 1 2 3 4 5 6 1998 2002 Cases per 0 live births Figure 29 Neonatal mortality infants dead within 28 days per 1 000 live births, 2003 2007. Age standardised. Source: Medical Birth Register, National Board of Health and Welfare 0.75 0.90 0.95 0.96 0.99 1.01 1.03 1.05 1.05 1.12 1.13 1.13 1.14 1.24 1.25 1.25 1.30 1.32 1.33 1.35 1.52 1.56 0,0 0,5 1,0 1,5 2,0 1998 2002 Percent Figure 30 Percentage of newborns with Apgar score under 7 at five minutes, 2003 2007. Age standardised. Source: Medical Birth Register, National Board of Health and Welfare 26 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
pregnancy, childbirth and neonatal care 2.67 2.73 2.81 2.85 3.05 3.10 3.12 3.20 3.25 3.40 3.49 3.89 3.90 3.98 4.00 4.12 4.15 4.20 4.42 4.65 4.85 4.89 0 1 2 3 4 5 6 1998 2002 Percent Figure 31 Women Percentage of third and fourth degree perineal tear during vaginal delivery, 2003 2007. Age standardised. Source: Medical Birth Register, National Board of Health and Welfare 5.83 5.99 6.09 6.36 6.38 6.85 7.44 7.63 7.65 7.73 7.83 7.95 8.08 8.26 8.30 8.36 9.10 9.14 9.16 9.20 9.38 9.44 0 5 10 15 20 25 Uncomplicated pregnancy Single births among primaparas, ages 20 34 Percent Figure 32 Women Caesarian section in uncomplicated pregnancy and in all single births among primaparas, 2003 2007. Ages 20 34. Source: Medical Birth Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 27
gynaecological care 0.81 1.02 1.09 1.12 1.30 1.39 1.40 1.53 1.57 1.68 1.72 1.74 1.74 1.84 2.01 2.01 2.18 2.31 2.36 2.43 2.89 3.08 0 1 2 3 4 5 Percent Figure 34 Women Adverse events after hysterectomy, 1998 2008. Ages 15 84. Age standardised. Source: National Patient Register, National Board of Health and Welfare 0.0 0.0 0.0 0.0 0.0 0.4 1.2 1.2 1.9 3.6 4.1 4.8 6.7 7.1 8.5 9.4 11.0 11.1 11.7 12.4 26.9 50.8 Response rate 67 97 87 0 10 20 30 40 50 60 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 2009. Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions 28 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
gynaecological care 0.0 0.0 1.4 1.8 1.9 3.3 3.5 3.5 4.1 4.1 4.3 5.1 5.4 5.9 6.0 6.3 7.7 9.8 11.4 13.9 16.8 29.0 October 2008 Response rate 67 99 0 10 20 30 40 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 2009. Source: National database on Waiting Times, Swedish Association of Local Authorities and Regions 52.0 45.8 33.9 21.4 19.8 18.9 16.9 15.1 13.8 13.7 11.7 6.4 5.9 4.9 3.5 1.5 1.3 1.2 0.8 0.5 0.0 0.0 0 10 20 30 40 50 60 2007 Percent Figure 37 Women Prolapse of the uterus percentage of day-case surgery, 2008. Source: National Patient Register, National Board of Health and Welfare. QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 29
musculoskeletal diseases 98.9 98.0 97.9 97.5 97.3 97.1 96.9 96.7 96.6 96.4 96.3 96.2 96.1 95.9 95.9 95.9 95.4 94.9 94.5 94.4 93.6 91.8 0 20 40 60 80 Percent Figure 39 Women Total knee arthroplasty 10-year implant survival, 1998 2007. Source: Swedish Knee Arthroplasty Register 99.6 99.0 98.8 98.4 97.7 97.3 97.2 96.9 96.8 96.7 96.6 96.3 96.2 96.0 95.7 95.3 94.4 94.2 94.2 93.3 91.2 86.2 0 20 40 60 80 Percent Figure 39 Men Total knee arthroplasty 10-year implant survival, 1998 2007. Source: Swedish Knee Arthroplasty Register 30 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
musculoskeletal diseases 98.5 98.2 97.7 97.5 97.4 96.7 96.7 96.3 96.2 96.2 96.1 96.0 95.9 95.9 95.7 95.2 94.9 94.5 94.1 93.9 93.4 93.3 0 20 40 60 80 Percent Figure 40 Women Total hip arthroplasty 10-year implant survival, 1999 2008. Source: Swedish Hip Arthroplasty Register 97.6 97.5 97.3 97.3 97.1 96.7 95.6 95.0 94.1 93.9 93.8 93.7 93.4 93.3 93.3 93.0 92.5 91.9 91.5 91.1 89.0 81.6 0 20 40 60 80 Percent Figure 40 Men Total hip arthroplasty 10-year implant survival, 1999 2008. Source: Swedish Hip Arthroplasty Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 31
musculoskeletal diseases 0.6 0.6 0.9 1.2 1.3 1.4 1.4 1.5 1.5 1.6 1.7 1.7 1.8 1.9 2.0 2.0 2.0 2.1 2.1 2.1 2.3 2.3 0 1 2 3 4 2002 2005 Percent Figure 41 Reoperation within 2 years after total hip arthroplasty, 2005 2008. Source: Swedish Hip Arthroplasty Register 32 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
musculoskeletal diseases 0.450 0.439 0.436 0.434 0.424 0.416 0.415 0.400 0.390 0.388 0.387 0.386 0.381 0.378 0.376 0.374 0.371 0.371 0.370 0.351 0.327 0.293 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 Index Figure 42 Women Patient-reported outcome after total hip arthroplasty, 2002 2008. Improvement in EQ5D after one year. Source: Swedish Hip Arthroplasty Register 0.454 0.443 0.398 0.385 0.385 0.378 0.378 0.374 0.364 0.357 0.354 0.351 0.348 0.343 0.327 0.318 0.316 0.305 0.301 0.292 0.292 0.194 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 Index Figure 42 Men Patient-reported outcome after total hip arthroplasty, 2002 2008. Improvement in EQ5D after one year. Source: Swedish Hip Arthroplasty Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 33
musculoskeletal diseases 2.70 2.75 2.87 2.89 2.91 2.99 3.00 3.08 3.33 3.35 3.42 3.44 3.61 3.73 3.79 3.86 3.90 3.96 3.98 4.06 4.10 4.37 0 2 4 6 8 10 2003 2005 Percent Figure 43 Adverse events within 30 days after knee and total hip arthroplasty, 2006 2008. Age standardised. Source: National Patient Register, National Board of Health and Welfare 1 1 1 15 17 19 20 22 23 23 23 24 24 25 25 27 27 27 27 29 30 30 0 10 20 30 40 50 60 1 No data available 2007 Hours Figure 44 Waiting times for hip fracture surgery after arrival at hospital, 2008. Source: National Hip Fracture Registry 34 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
musculoskeletal diseases 68.4 67.0 65.6 65.5 64.0 62.7 61.9 61.4 61.3 61.3 61.3 59.5 59.0 58.1 58.0 55.0 54.0 53.7 52.3 51.8 43.3 40.9 0 20 40 60 80 2005 2006 Percent Figure 45 Women Percentage of femur fracture patients 65 years and older who undergo arthroplasty, 2007 2008. Age standardised. Source: National Patient Register, National Board of Health and Welfare 67.7 67.2 59.7 58.4 58.3 57.8 55.8 52.6 51.5 49.4 49.2 48.3 47.6 46.6 44.4 44.2 44.0 43.2 42.3 41.0 33.0 24.4 0 20 40 60 80 2005 2006 Percent Figure 45 Men Percentage of femur fracture patients 65 years and older who undergo arthroplasty, 2007 2008. Age standardised. Source: National Patient Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 35
musculoskeletal diseases 30.5 27.5 27.0 26.7 25.4 24.0 23.4 23.2 23.1 23.0 22.9 22.9 22.9 22.6 22.4 22.4 22.1 21.8 21.8 20.9 19.7 17.6 0 10 20 30 40 Percent Figure 46 Women Percentage of women age 55 and older with fractures who received osteoporosis drugs within 6 12 months, 2006 2008. 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
musculoskeletal diseases 321.4 273.3 237.8 236.1 231.2 225.8 223.8 217.1 216.4 206.6 202.8 197.7 188.7 170.2 168.3 160.0 159.0 158.6 149.8 146.0 125.8 103.1 0 200 300 400 Cases per 000 inhabitants Figure 47 Women Patients treated with biological drugs for rheumatoid arthritis per 000 inhabitants, 1 January 2009. Age 18 and older. Source: Swedish Rheumatology Register 152.2 137.9 136.9 135.2 132.0 126.9 113.9 112.5 106.5 105.2 103.6.0 90.2 87.9 86.2 86.1 85.4 80.5 80.4 60.7 60.3 48.4 0 200 300 400 Cases per 000 inhabitants Figure 47 Men Patients treated with biological drugs for rheumatoid arthritis per 000 inhabitants, 1 January 2009. Age 18 and older. Source: Swedish Rheumatology Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 37
musculoskeletal diseases 1 1 2 51.9 50.5 50.0 47.2 45.4 44.0 39.7 39.1 38.7 37.7 37.5 34.9 34.5 32.7 32.6 31.1 30.9 29.8 10.2 Number of patients 3 7 23 22 14 54 59 450 1 260 75 146 71 14 34 14 121 29 41 23 21 39 0 10 20 30 40 50 60 70 1 2 2003 2005 Less than 10 cases No data available Percent Figure 48 Rheumatoid arthritis patient reported health improvement six months after commencement of treatment, 2006 2008. Source: Swedish Rheumatology Register 0.2 0.7 2.2 6.3 7.9 8.1 11.1 11.6 12.7 15.0 15.7 16.7 22.6 22.9 29.6 30.7 32.0 44.6 46.9 47.2 56.1 57.1 October 2008 Response rate 0 20 40 60 80 84 97 Percent Figure 49 Orthopedic outpatient visit percentage of patients with waiting times longer than 90 days of all on the waiting list, 30 April 2009. Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions 38 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
musculoskeletal diseases 0.0 0.0 1.1 2.0 4.4 5.4 6.2 7.8 8.2 9.0 9.8 9.9 10.7 11.7 12.3 13.4 13.9 14.4 23.0 23.1 25.1 25.8 Oktober 2008 Response rate 0 20 40 60 80 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 2009. Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 39
musculoskeletal diseases Figure 51 Women 91.0.4 102.2 114.5 119.3 152.7 155.6 159.1 159.4 162.7 170.1 173.8 174.3 175.6 175.9 185.9 204.3 214.5 237.0 249.5 268.9 348.5 0 200 300 400 500 600 2003 2005 Cases per 000 inhabitants Knee arthroscopy in patients with osteoarthritis or degenerative meniscus leison per 000 inhabitants, 2006 2008. Patients 40 years and older. Age standardised. Source: National Patient Register, National Board of Health and Welfare Figure 51 Men 140.3 149.8 153.8 155.7 211.9 215.7 216.5 228.8 236.7 241.5 261.3 261.3 265.0 269.7 281.5 284.5 292.6 296.6 299.9 350.1 362.9 482.4 0 200 300 400 500 600 2003 2005 Cases per 000 inhabitants Knee arthroscopy in patients with osteoarthritis or degenerative meniscus leison per 000 inhabitants, 2006 2008. 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
diabetes care 59.4 58.2 57.4 56.6 56.5 56.1 55.5 55.4 54.9 54.5 53.5 53.5 53.3 51.9 51.1 50.6 50.2 49.7 49.4 49.1 47.4 44.9 Level of participation in the register, % 66.6 61.6 70.5 54.0 84.7 56.7 83.9 67.8 77.2 80.6 40.1 58.3 64.7 46.3 37.0 82.8 48.3 76.5 73.2 48.5 45.1 71.1 0 20 40 60 80 Percent Figure 54 Women Percentage of diabetic patients in primary care who reach the goal for HbA1c (<=6.0), 2008. Age 18 80 years. Source: Swedish National Diabetes Register Level of participation in the register, % 58.3 61.6 54.0 53.8 53.7 53.6 53.4 52.1 51.8 51.5 51.4 51.1 50.9 49.8 49.1 49.1 47.9 47.1 47.1 46.3 44.7 44.0 41.9 66.6 67.8 84.7 83.9 70.5 54.0 64.7 46.3 40.1 58.3 77.2 80.6 45.1 56.7 48.3 76.5 82.8 73.2 48.5 37.0 71.1 0 20 40 60 80 Percent Figure 54 Men Percentage of diabetic patients in primary care who reach the goal for HbA1c (<=6.0), 2008. Age 18 80 years. Source: Swedish National Diabetes Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 41
diabetes care Level of participation in the register, % 43.0 83.9 41.6 41.4 40.5 39.9 39.6 39.4 39.1 38.8 38.7 38.6 38.3 37.4 37.1 36.7 35.8 34.2 34.1 32.0 32.0 30.4 29.7 71.1 77.2 56.7 84.7 46.3 61.6 40.1 66.6 67.8 70.5 58.3 45.1 48.5 76.5 73.2 80.6 54.0 37.0 48.3 64.7 82.8 0 20 40 60 80 Percent Figure 55 Women Percentage of diabetic patients in primary care who reach the blood pressure goal (<=130/80), 2008. Age 18 80 years. Source: Swedish National Diabetes Register Level of participation in the register, % 44.8 77.2 43.6 42.8 42.1 39.7 39.2 39.1 39.0 38.6 38.2 38.1 37.5 36.7 36.5 36.4 36.3 36.0 34.8 32.8 31.5 30.6 30.5 83.9 71.1 66.6 67.8 46.3 45.1 40.1 58.3 54.0 70.5 76.5 56.7 80.6 84.7 61.6 48.5 73.2 37.0 82.8 48.3 64.7 0 20 40 60 80 Percent Figure 55 Men Percentage of diabetic patients in primary care who reach the blood pressure goal (<=130/80), 2008. Age 18 80 years. Source: Swedish National Diabetes Register 42 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
diabetes care Level of participation in the register, % 42.6 46.3 41.7 40.8 39.5 37.6 35.4 34.2 34.2 33.9 33.8 32.3 32.1 32.0 32.0 31.9 31.8 31.3 30.6 30.2 28.3 26.0 21.9 83.9 76.5 66.6 48.3 70.5 61.6 58.3 84.7 71.1 56.7 82.8 40.1 67.8 37.0 73.2 80.6 45.1 77.2 48.5 64.7 54.0 0 20 40 60 80 Percent Figure 56 Women Percentage of diabetic patients in primary care who reach the blood lipids goal (<4,5 mmol/l), 2008. Age 18 80 years. Source: Swedish National Diabetes Register Level of participation in the register, % 55.0 46.3 52.4 51.0 50.4 50.2 49.3 45.9 45.9 44.8 44.5 44.1 44.0 43.9 43.8 43.6 42.9 42.9 41.8 41.2 40.9 38.9 33.6 83.9 48.3 70.5 76.5 66.6 56.7 58.3 84.7 71.1 61.6 77.2 40.1 67.8 82.8 64.7 80.6 73.2 45.1 37.0 48.5 54.0 0 20 40 60 80 Percent Figure 56 Men Percentage of diabetic patients in primary care who reach the blood lipids goal (<4,5 mmol/l), 2008. Age 18 80 years. Source: Swedish National Diabetes Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 43
diabetes care 66.9 64.0 63.7 62.5 61.9 61.7 61.7 61.3 60.4 60.2 58.2 57.5 56.7 56.5 56.2 56.0 55.2 55.2 55.1 55.1 53.2 49.5 0 20 40 60 80 July 2005 June 2006 Percent Figure 57 Women Percentage of diabetics receiving diabetes drug therapy who had lipid lowering drugs, July 2008 June 2009. Age 40 years and older. Age standardised. Source: Prescribed Drug Register, National Board of Health and Welfare 67.8 66.2 66.2 64.3 63.0 62.5 61.8 61.5 61.3 60.1 60.0 59.8 59.7 58.9 58.8 58.7 57.4 57.0 56.1 55.7 55.0 52.8 0 20 40 60 80 July 2005 June 2006 Percent Figure 57 Men Percentage of diabetics receiving diabetes drug therapy who had lipid lowering drugs, July 2008 June 2009. 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
diabetes care 62.3 50.8 50.6 43.4 35.0 34.0 32.6 32.3 32.3 32.2 31.9 31.6 31.1 31.1 28.4 25.6 25.1 24.6 24.0 23.7 23.6 20.2 0 20 40 60 80 Percent Figure 58 Percentage of child and adolescent diabetics who reach the goal for HbA1c ( 6,5 %), 2008. Age 18 years and younger. Source: Swedish National Diabetes Register 1.36 2.39 3.12 3.15 3.34 3.57 3.64 3.77 3.78 3.88 3.88 3.95 3.99 4.07 4.12 4.28 4.36 4.46 4.59 4.74 4.76 5.04 0 1 2 3 4 5 6 7 Cases per 1 000 patients Figure 59 Number of first time major amputations in 1 000 patients with diabetes, 2006 2008. 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 2009 45
cardiac care 18.9 22.9 23.7 24.6 24.7 24.9 25.9 27.4 28.1 28.2 28.2 28.4 28.6 28.6 28.8 29.6 30.6 30.7 30.7 31.5 31.8 33.1 0 10 20 30 40 Deaths without hospital care Deaths within 28 days 2002 2004 Percent Figure 60 Women 28-day case fatality rate for myocardial infarction, 2005 2007. 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 25.1 27.7 28.0 28.5 28.8 29.6 29.7 29.8 30.5 30.7 31.0 31.1 31.4 31.5 31.5 31.9 32.0 33.7 34.3 34.4 34.4 37.3 0 10 20 30 40 Deaths without hospital care Deaths within 28 days 2002 2004 Percent Figure 60 Men 28-day case fatality rate for myocardial infarction, 2005 2007. 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
cardiac care 1 7.9 12.3 12.8 12.9 12.9 13.0 13.3 13.5 13.5 13.5 13.6 13.6 14.0 14.1 14.4 14.4 14.7 14.7 14.8 15.0 15.1 16.0 0 5 10 15 20 25 2003 2005 1 Preliminary data Percent Figure 61 Women 28-day case fatality rate for myocardial infarction, 2006 2008. Hospitalised patients. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare 1 12.3 12.7 13.0 13.3 13.6 13.8 13.9 14.0 14.6 14.6 14.6 14.8 14.8 14.9 15.0 15.6 15.7 15.8 16.0 16.2 16.4 17.4 0 5 10 15 20 25 2003 2005 1 Preliminary data Percent Figure 61 Men 28-day case fatality rate for myocardial infarction, 2006 2008. 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 2009 47
cardiac care Figure 62 Women 6.9 7.6 8.0 8.3 8.4 9.4 9.5 10.9 11.2 11.6 11.7 11.9 11.9 11.9 12.5 12.6 13.1 13.4 14.1 14.9 15.3 15.6 0 5 10 15 20 25 2005 Percent Percentage of patients with first-time myocardial infarction that recurs within 365 days, 2006. 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 5.6 9.8 9.9 10.1 10.8 11.4 11.5 12.3 12.4 12.4 12.6 12.9 12.9 13.1 13.6 13.6 14.2 14.3 14.6 15.1 15.3 15.4 0 5 10 15 20 25 2005 Percent Percentage of patients with first-time myocardial infarction that recurs within 365 days, 2006. 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
cardiac care 1 92.6 88.2 88.2 87.9 84.2 82.0 79.2 78.9 78.8 78.0 77.8 77.3 77.2 76.4 75.0 74.2 73.1 72.2 65.4 62.2 58.3 Percentage treated according to target 43.5 43.3 67.2 64.3 68.3 76.3 55.6 63.3 62.2 56.7 65.7 64.7 72.2 66.4 52.2 47.4 38.9 68.0 55.2 36.4 40.0 50.0 0 20 40 60 80 1 Less than 10 patients PCI, CABG Thrombolysis 2006 Percent Figure 63 Women Reperfusion therapy for patients with ST-segment elevation myocardial infarction, 2008. Patients younger than 80. Source: SWEDEHEART.0 89.0 88.7 88.2 86.8 86.8 86.4 85.6 85.3 85.3 85.1 84.7 83.9 83.6 82.4 81.0 81.0 79.2 78.5 72.8 71.9 68.0 Percentage treated according to target 44.4 68.8 57.5 35.7 47.3 53.5 62.1 65.0 68.4 66.2 75.5 73.2 64.0 46.7 56.4 73.1 58.3 67.5 78.1 46.0 69.8 48.4 0 20 40 60 80 PCI, CABG Thrombolysis 2006 Percent Figure 63 Men Reperfusion therapy for patients with ST-segment elevation myocardial infarction, 2008. Patients younger than 80. Source: SWEDEHEART QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 49
cardiac care 91.4 84.7 82.7 82.4 78.6 78.1 77.9 77.9 77.0 76.7 76.0 75.6 74.3 72.4 70.0 68.5 68.1 64.3 63.6 63.6 61.3 58.8 0 20 40 60 80 2006 Percent Figure 64 Women Coronary angiography after non-st-segment elevation myocardial infarction and another risk factor, 2008. Patients younger than 80. Source: SWEDEHEART 89.4 88.5 88.1 85.6 85.3 84.3 83.3 83.0 82.5 81.8 80.8 79.7 78.8 78.8 78.4 77.8 77.8 77.7 77.0 70.0 69.0 62.5 0 20 40 60 80 2006 Percent Figure 64 Men Coronary angiography after non-st-segment elevation myocardial infarction and another risk factor, 2008. Patients younger than 80. Source: SWEDEHEART 50 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
cardiac care 95.8 93.0 92.9 92.7 92.6 91.5 89.6 88.2 87.7 87.0 86.8 86.3 84.5 83.6 83.0 83.0 80.9 80.6 80.4 79.4 63.2 61.0 0 20 40 60 80 2006 Percent Figure 65 Women Clopidogrel therapy after non-st-segment elevation myocardial infarction, 2008. Patients younger than 80. Source: SWEDEHEART 95.9 95.7 95.5 93.4 93.1 93.0 93.0 92.8 91.1 91.1 90.6 90.5 90.4 89.3 89.1 88.9 88.0 87.1 87.0 85.6 85.5 83.6 0 20 40 60 80 2006 Percent Figure 65 Men Clopidogrel therapy after non-st-segment elevation myocardial infarction, 2008. Patients younger than 80. Source: SWEDEHEART QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 51
cardiac care 90.1 88.3 87.8 86.5 86.0 85.5 84.9 84.9 83.9 83.7 83.7 83.5 82.9 81.8 81.2 79.8 79.2 79.2 78.9 78.6 74.6 69.3 0 20 40 60 80 2005 2006 Percent Figure 66 Women Lipid lowering drug therapy 12 18 months after myocardial infarction, 2006 2007. Patients aged 40 79. Age standardised. Source: National Patient Register and Prescribed Drug Register, National Board of Health and Welfare 91.6 88.5 88.3 87.9 87.8 87.5 87.5 86.7 86.6 86.5 85.9 85.4 85.3 85.1 85.0 84.8 84.2 83.1 82.0 82.0 81.5 78.6 0 20 40 60 80 2005 2006 Percent Figure 66 Men Lipid lowering drug therapy 12 18 months after myocardial infarction, 2006 2007. Patients aged 40 79. 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
cardiac care 16.3 16.6 17.1 17.2 18.6 18.9 19.1 19.1 19.3 19.4 20.0 20.1 20.3 20.4 20.8 20.9 22.2 22.2 22.4 23.0 23.8 24.6 0 10 20 30 40 2001 2004 Percent Figure 67 Women Readmission for heart failure or death within 30 days for patients hospitalised for heart failure, 2005 2008. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare 17.1 17.9 18.5 18.8 19.8 20.4 20.4 20.9 21.3 21.6 21.6 22.1 22.2 22.7 22.7 23.1 23.3 23.7 24.2 24.3 24.7 26.5 0 10 20 30 40 2001 2004 Percent Diagram 67 Men Readmission for heart failure or death within 30 days for patients hospitalised for heart failure, 2005 2008. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 53
cardiac care Number of cases 1 4 3.0 4.0 5.0 5.0 7.0 7.0 8.0 8.0 8.0 8.0 9.0 10.0 11.5 12.0 12.5 16.5 17.5 19.0 20.5 23.0 27.0 12 13 10 33 104 146 31 30 17 22 47 764 22 138 14 26 16 11 12 19 37 0 10 20 30 40 1 Less than 10 patients 2007 Days Figure 68 Women Median waiting time between decision to operate and performance of coronary artery bypass graft, 2008. Source: SWEDEHEART Number of cases 6.5 150 7.0 7.0 8.0 8.0 10.0 10.0 10.0 10.5 11.0 11.5 12.0 12.0 12.0 13.0 14.0 46 84 127 13 462 517 77 36 141 108 67 76 2910 94 494 20.0 89 21.5 22.0 22.0 24.0 29.0 70 53 104 62 40 0 10 20 30 40 2007 Days Figure 68 Men Median waiting time between decision to operate and performance of coronary artery bypass graft, 2008. Source: SWEDEHEART 54 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
cardiac care 1 0.0 0.0 0.0 0.7 1.7 2.7 2.8 4.8 8.4 11.7 13.3 14.4 16.9 19.4 22.4 24.7 26.7 29.6 43.4 55.2 57.5 Response rate 2009 90 98 0 20 40 60 80 1 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, 2009. Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 55
stroke care 17.8 18.0 20.2 21.3 21.7 22.1 22.3 22.5 22.5 22.5 22.7 23.0 23.0 23.4 23.8 24.3 24.7 24.7 25.3 25.5 26.0 28.2 0 10 20 30 40 28 days 90 days 2002 2004 Percent Figure 71 Women 28-day case fatality rate for first-ever stroke, 2005 2007. Both hospitalised patients and those who died without being hospitalised. Source: Patient Register and Cause of Death Register, National Board of Health and Welfare 16.5 18.5 18.8 18.9 20.4 20.8 21.2 21.4 21.5 21.7 21.7 21.8 22.4 22.6 22.9 23.0 23.3 23.7 23.7 23.9 27.0 28.3 0 10 20 30 40 28 days 90 days 2002 2004 Percent Figure 71 Men 28-day case fatality rate for first-ever stroke, 2005 2007. 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
stroke care 11.6 13.1 13.7 13.8 14.0 14.2 14.2 14.4 14.6 14.6 14.7 14.7 15.0 15.0 15.2 15.4 15.9 16.0 16.6 17.6 18.3 18.7 0 5 10 15 20 25 30 28 days 90 days 2003 2005 Percent Figure 72 Women 28-day case fatality rate for first-ever stroke, 2006 2008. Hospitalised patients. Age standardised. Source: National Patient Register and Cause of Death Register, National Board of Health and Welfare 11.1 12.6 13.1 13.2 13.3 13.4 14.1 14.3 14.4 14.5 14.6 14.8 14.9 15.2 15.3 15.5 16.2 16.2 16.2 17.5 17.6 19.6 0 5 10 15 20 25 30 28 days 90 days 2003 2005 Percent Figure 72 Men 28-day case fatality rate for first-ever stroke, 2006 2008. 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 2009 57
stroke care Completeness compared to National Patient Register 95.1 95.1 92.9 92.7 91.2 89.8 88.1 87.0 86.8 86.6 86.2 84.8 84.1 82.5 82.5 81.3 80.8 80.0 77.6 75.0 74.2 70.9 0 20 40 60 80 85.1 75.4 81.7 86.9 83.3 82.3 83.8 82.3 63.0 83.7 84.1 86.5 80.3 91.0 83.4 88.1 88.4 88.7 88.5 83.6 91.3 83.5 2006 Percent Figure 73 Women Percentage of stroke patients treated at a special stroke unit, 2008. Source: Swedish Stroke Register 95.2 94.0 93.7 92.0 91.3 91.2 90.9 90.6 88.8 87.8 87.5 86.2 86.2 85.6 85.6 84.9 81.1 79.6 79.2 78.3 78.1 73.9 Completeness compared to National Patient Register 85.1 81.7 75.4 83.3 83.8 63.0 82.3 86.9 88.4 82.3 83.7 86.5 80.3 88.1 84.1 83.4 88.7 91.0 88.5 83.5 91.3 83.6 0 20 40 60 80 2006 Percent Figure 73 Men Percentage of stroke patients treated at a special stroke unit, 2008. Source: Swedish Stroke Register 58 QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009
stroke care 17.5 12.1 9.4 9.3 9.1 8.9 8.2 7.9 7.4 6.7 6.7 6.7 6.5 6.5 5.9 5.6 5.5 5.0 4.3 4.2 3.9 3.1 Number of treated patients 11 31 184 39 144 33 37 14 825 120 24 29 12 22 8 17 22 15 17 20 14 12 0 10 20 30 40 50 2006 Percent Figure 74 Percentage of eligible stroke patients who receive thrombolytic therapy, 2008. Source: Swedish Stroke Register QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2009 59
stroke care 1 87.8 86.8 76.0 76.0 75.5 75.5 72.8 69.0 66.9 66.7 63.8 62.2 60.5 60.4 60.3 58.9 58.5 57.8 54.3 53.6 47.1 0 20 40 60 80 1 Less than 10 patients 2005 2006 Percent Figure 75 Women Anticoagulant therapy after 12 18 months for stroke patients with atrial fibrillation, 2006 2007. Age 55 79. Age standardised. Source: National Patient Register and Prescribed Drug Register, National Board of Health and Welfare 1 86.0 85.4 81.4 76.5 74.9 71.9 71.6 70.4 66.0 64.0 63.2 62.2 61.7 61.3 60.8 60.6 60.3 58.2 58.1 58.0 54.3 0 20 40 60 80 1 Less than 10 patients 2005 2006 Percent Figure 75 Men Anticoagulant therapy after 12 18 months for stroke patients with atrial fibrillation, 2006 2007. Age 55 79. 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