Introduction
Sweden has about 70 national quality registries, which mostly are web-based, i.e., data are entered into the registries using web-based questionnaires. The definition of a Swedish quality register is: “A national quality registry contains individualised data concerning patient problems, medical interventions, and outcomes after treatment; within all healthcare production. It is annually monitored and approved for financial support by an Executive Committee” [1]. One of these 70 quality registries is the Swedish National Diabetes Register (NDR). This quality register was implemented in 1996 as a response to the St. Vincent Declaration's requirement in 1989 to assess the quality in diabetes care [2].
The NDR allows primary healthcare centres (PHCCs) to measure quality based on the indicators listed in the national guidelines for diabetes care and make national comparisons [3], [4], [5]. The PHCCs can follow their quality work regularly and analyse their data through immediate access to their own results in haemoglobin A1c (HbA1c), body mass index, lipids, blood pressure, preventive treatment, various risk factors, diabetes complications and physical activity [6], and with national benchmarks always being updated. The analyses of the data at the PHCCs can be performed using a web-based interface or a stand-alone program, depending on the reporting system used. This allows the PHCCs to continuously monitor changes or improvements made at their PHCC [7].
Since 2003 PHCCs have had the opportunity to be supported in their quality work in diabetes care by participating in the NDR quality work project (NDR-IQ), consisting of education for the PHCC teams and follow-up of changes in quality indicators [7]. This kind of quality improvement project has been found to influence the effectiveness of feedback [8]. Further, the NDR produces an annual report for each PHCC with comparative national statistics as well as an annual report for the national survey [7]. All county councils have appointed co-ordinators that can order regional statistics for their respective county council. The NDR invites these co-ordinators to an annual meeting to inform them and allow them to discuss news, problems and the latest results.
In 2006, ten years after the implementation of the NDR, almost 80% of PHCCs reported data on their adult patients with diabetes to the NDR, but only one-third of patients were reported from the PHCCs [9]. The fact that two-thirds of patients with diabetes were not reported to the register gave rise to the question: What factors facilitate the reporting of patients to a diabetes quality register such as the NDR? One hypothesis was that the reporting system used by the PHCCs for reporting data to the NDR may be a key factor for answering this question.