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Empowering patients to need less care and do better in Highland Hospital, South Sweden

Performance Indicators

In order to ensure that this approach to treatment did not decrease the quality of care, an extensive performance measurement system was used, covering the medical results, the patients’ health and illness experiences, waiting times for referral visits and waiting time for endoscopic procedures. These involved questionnaire investigations of the patients’ experience of care (both at home and as in-patients), and, in order to monitor medical results, use of our computerised medical register of diagnoses, simple biochemical markers and patients’ experience of health. We also did one-off investigations, e.g. analysis of our pharmacy records to assess patients’ adherence to recommended drug treatment.

Health condition: The patients self-assess their health on the Short Health Scale form, reflecting four aspects of their health - symptom burden, function, experience of anxiety and general condition. Positive results are reported by the following proportions of our patients:

  • symptom burden : 98% for ulcerative colitis, 96% for Crohns disease ;
  • functionality in daily life : 96% for ulcerative colitis, 86% for Crohns disease
  • anxiety : 94% for ulcerative colitis, 90% for Crohns disease ;
  • general health condition : 95% for ulcerative colitis, 95% for Crohns disease.

Satisfaction: Patient and staff satisfaction are measured by questionnaire. Both groups have reported high levels of satisfaction with the redesigned care system.

Availability: Referrals are registered in a computerised system and the number of patients coming for revisits in the ward is recorded manually – all data is presented once a week at the clinic review meeting. The goal is to have no waiting lists for re-visits, less than 14 days waiting time for referral patients, less than 3 days waiting time for urgent visits and immediate availability for all phone contacts. In practice, there is now no waiting list for planned revisits nor for urgent visits. Telephone availability is good – 93% of incoming calls are answered within 3 minutes. For referral visits, the average waiting time for nonprioritised referrals in 2006 was 23.5 days. (The first 7 days is taken up in handling the referral, before it is passed to the clinic, so the actual time taken from when the referral is made to the clinic until the patient actually visits us is only 16.7 days on average).

Adherence to drug treatment: Available international studies show that adherence to recommended treatment with 5-ASA-preparations (an important maintenance treatment) is as low as 30 – 50%. Our records show 68% of patients with total ulcerative colitis have taken out from the pharmacy more than 70% of their prescribed dose, and for left-sided colitis the figure is 58%.

Medical: The number of hospitalisations of patients with inflammatory bowel disease decreased 48% during the period 1998 – 2005,  compared to the nationwide decrease of 4% reported by the National Board of Health. Our clinic has moved from above the national average of in-patients per 100,000 residents to being almost half the national average during this period (see figure 14). The number of unscheduled visits of patients with flare-ups in their condition decreased from two a day in 2001 to two a week in 2005, mainly, we believe, because patients are taking more responsibility for their own care and therefore are contacting us much earlier when there is a flare-up in their condition, before they become really ill.
Medical quality: We have used as an important medical target that 95% of the patients should have a Hb > 120 – this has been achieved for 97% of patients with ulcerative colitis and for 94% of patients with Crohns disease. We know that the use of haemoglobin levels as a quality indicator is not widely accepted ; however, we know from several studies that anaemia frequently follows on from IBD – indeed, in some studies 30% of patients are anaemic. The number of patients with anaemia should therefore be an indicator of the unit’s ability to discover and treat anaemia, so that being able to keep this number low is probably an indicator of quality.


About this case study
Main Contact

Dr. Jörgen Tholstrup
Chief Medical Officer
Highland District County Hospital
Eksjö, Sweden


Dr. Jörgen Tholstrup provided Governance International  with this case study on 30 March 2010. The case study was updated in June 2014.

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