By Tina Eriksson
The purpose of the newly formed organisational structure is to coordinate and generate quality development in collaboration with the secondary health care system through a common quality program; the Danish National Quality Programme.
The organisational structure comprises the DAK-Unit, KIF - a family medicine quality and informatics fund, a family practice data base (DAMD), and an expert committee on quality in primary care.
All developments are financed by the means from the new cooperative agreement in 2006 between the Danish GP’s labour organisation (PLO) and the national health services bargaining committee (SFU), the represent Danish regions- the units that organises health care in Denmark.
A chromic care system is being organised with emphasis on a new way to organise and use incentives in general practice. Moreover a data capture system and a general practice specific data base for a range of purposes, such as sentinel registrations and monitoring and feed back of quality indicators is being established.
The DAK-Unit
A new national Danish general practice quality unit (DAK-E) established with Søren Friborg in front. The aims are to support the QI development on a national level, main focus on IT developments, and development of national quality indicators and elements of shared care.
Consultants: Henrik Schroll (leader of the IT development branch), Lars Rytter (leader of the shared care and chronic care branch), Jørgen Steen Andersen (Leader of indicator development). Moreover Tina Eriksson has research and international collaborations as her main focus; Jesper Lundh is educational consultant and Poul Brix organisational expert. Gitte Hove leads the DanPEP project, Rikke Primdahl and Lone Østerhåb takes care of the secretariat. You can look at the DEK-E website www.dak-e.dk unfortunately it is in Danish only.
The Foundation of Quality and Informatics - KIF
The aims of the KIF is to support and finance new national QI initiatives in primary care within quality and informatics. The board comprises representatives of the Danish GP’s labour organisation (PLO), the Danish Regions and the Danish College of General Practitioners.
IT developments
The Danish ICPC code network. In Denmark 90% of GPs use electronic patient journal systems and have access to the Internet and communication lines to hospitals and pharmacies. However, further IT-developments require uniform and good ICPC coding of health problems and procedures during consultations. The quality of the ICPC coding depends on whether GPs find coding useful in their daily clinical practice rather than on legislation and financial incentives
The Link Portal, how GPs obtain information from internet databases about patient care during consultations
During consultations, GPs often need specific information such as diagnose criteria, treatment guidelines and investigation schemes prior to referral. An average consultation length of ten minutes leaves little space for information search. About 90 % of Danish GPs use the Electronic Patient Journal (EPJ) and have access to electronic communication lines to hospitals and pharmacies and a connection to the Internet. The aim of this project is to create an electronic link from the GPs PC to comprehensive and specific information, retrievable during consultations.
By writing an ICPC-code directly in the patients’ electronic journal, the GP is connected to an Internet site named “The Link Portal”, and presented information, relevant to the ICPC-code. To make that possible, all documents on “The Link Portal” must be indexed by an ICPC code.
The Link Portal has been completed and implemented in the 12 EPJ systems currently in use in Denmark. It has been evaluated and given over for use in general practice. In the pilot phase the Norwegian Electronic Physicians Manual was used as a source of clinical information. The DAK-B group has supported a systematic coding of county documents concerning organisation of the health care system on county level.
The Data-Capture Module (DCM), a Danish invention that collect data from a range of different EPJ software systems in general practice.
When collecting systematic data concerning day to day work in general practice it is crucial that valid data can be obtained with a minimum time and effort for the GP. The idea of the Data-Capture Module is to catch data from the GPs PC system while he is working and with none or little disturbance of the GP. Method: The development of the
Most of the routine data are collected automatically of the DCM in quality assurance project and in research projects. The capture of unstructured information can be triggered by different "events", such as setting an ICPC-code, the prescription of a medication or ordering of a test etc. Results: The data can be obtained and used for different purposes: 1) GPs surveillance of own quality of work; 2) sentinel registration of GPs'' work; and 3) collection of specific data for research purposes. The module is still under construction and will be ready for use in April 2005. Discussion:
The programming of the Data-Capture Module has been completed and all 14 EPJ systems have been cerified in its use for collecting data on e.g. indicators of diabetes care and electronic audits. The data are stored in DAMD.
The family practice data base - DAMD
DAMD is a general practice specific database and in that sense it is the first of its kind in Denmark. Other clinical data bases houses data on a single clinical entity only. To establish the data base a change of the data regulation law will probably be necessary. Right now it is working on dispensation from data regulation rules.
It is important for GPs to send data to a data base run by an organisation that GPs trust and it is important that GPs receive their data back in a comprehensive form. Moreover it is not possible for single GPs to establish cooperation with a range of clinical data bases that also houses data from the secondary health sector. It is planed that cooperation will be established through the DAMD.
A DAMD steering committee, an expert group and a centre of competences has been assigned to the DAMD database.
The regional quality work
The five Danish regions are designing their local organisation of quality work in different ways and the different regions are also at very different stages of their organisation. In general there are attempts to enhance cooperation between CME, QI-work and research in the regional organisations. We expect to be able to present the regional organisation in more detail later this year.
