The National Board of Health and Welfare (NBHW) has developed a multi-dimensional performance assessment framework for open comparisons and assessment of health care. The framework includes the dimensions effectiveness, safety, patient-centeredness, timeliness, equity and efficiency.

To apply the framework to the area of psychiatric care in Sweden.

To identify disparities in the treatment and health outcomes of psychiatric patients in order to stimulate improvements.

More than 30 process and outcome indicators were developed using nationwide health data registers and were compared among regions or between patient groups.

Among other results the study shows large disparities in somatic care between patients with and without comorbid psychiatric disease (equity), low compliance to antidepressant treatment with small regional variations (effectiveness), decreasing suicidal rates (safety), regional variations concerning timeliness of care, lack of national data to asses patient-centeredness and no obvious relationship between costs of psychiatric care and outcome (efficiency).

The study indicates that the quality of psychiatric care in Sweden does not differ to any great extent between regions. However, there are large disparities in somatic care between patients with and without comorbid psychiatric disease. The framework is a useful starting point for assessing psychiatric care but improved reporting to existing registers and development of new data sources, particularly related to psychiatric health care outcomes, could lead to more adequate and comprehensive assessments including all the six dimensions of the framework.