The forms are filled in and registered into the registration system by health professionals, mostly nurses on the wards. If necessary, physicians are asked regarding surgical technique and fracture type. Most parameters can be found in the medical record. Patients indicate their quality of life through the EQ-5D form.

Since 2005 all registration is made on the web.

There is a need to know not only how much medical treatment costs, but also what the quality of the care is. It is widely acknowledged that the Swedish registers also are helping to improve medical care by showing what can be obtained with different procedures. Nowadays, the basis of improvement of daily care has developed into open comparisons between regions and also between hospitals. For these open comparisons, the data must be calculated and interpreted by the medical profession to avoid misjudgements based on case-mix considerations and incomplete data.

In Sweden, our experience after decades of national registration is that the patients are not against the idea of registration. Instead, most of them want to gain some benefit from the registers by knowing the results of different procedures. After receiving such information, a patient seldom refuses registration. In the case of patients with dementia, the relatives or guardians have the same attitude. No written consent is required. However, information must be given regarding the registration and the patient can refuse registration.

One particular factor that facilitates registration in Scandinavia is the system with national personal identification numbers, which makes it possible to trace patients through the medical system, and also the fact that each city usually has only one hospital. There are also national arthroplasty registers in Norway, Finland, and Denmark. Many Swedish registers are now internet-based, and an authorized person can gain access to the data using a username- password security system

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