Programme 4D

Programme 4D (”D” as in diagnoses) was a collaboration programme between Karolinska Institutet (KI) and the Stockholm County Council (SCC). The overall aim of Programme 4D was to improve the health of and increase participation of the individual.

The four diagnoses are based on their high prevalence and health impact:

  • arthritis
  • breast cancer
  • diabetes type 2
  • heart failure

This knowledge will be applied from research to the healthcare system in the form of new or improved treatment, prevention or diagnostics. The programme is thus composed of five main projects, which in turn include approximately 27 sub-projects and will extends over the period 2012-2017.

Informatics as a common denominator

Programme 4D also includes a separate project for informatics to enable the linkage of medical records, patient e-health accounts, quality registers and biobanks.

Research related to the programme

Several research projects are linked to Programme 4D. Aimed at bridging knowledge gaps, these projects include a study of the distinction between two types of heart failure and an evaluation of three different methods for population screening for pre-diabetes and diabetes type 2.

New systems for identifying and diagnosing people with newly onset arthritis are being developed. In addition, a risk model for identifying women who may develop breast cancer will be created and tested, as will a breast cancer prognosis evaluation protocol.

Cooperation between all participants

The ambition of Programme 4D is to increase the cooperation between all participants in the health and medical care process; research, health care and industry.

Aim and objective

The overall aim of Programme 4D is to improve the health of and increase participation of the individual.

The aim is to improve conditions for healthcare and research to enable the rapid transfer of knowledge to personalized prevention, early diagnostics and treatment.
The objective is to design generalizable models suitable for the majority of diagnoses.

Examples of generalizable models include decision support for patients, handling of informed consent for research; participation by patients; decision support for healthcare; and support for research in the use of various types of data (eg, biobanks and quality registers). This may involve an e-health tool for the patient that links medical record data to healthcare data, thereby also serving as research data and decision data for both the patient and the healthcare system.

All in all, Programme 4D will promote a cohesive health and medical care process in which the individual takes an active part. Research projects linked to 4D will identify and bridge knowledge gaps. The initiative will also support the development and quality of the healthcare organization as a whole and the development of innovations in collaboration with the industry.
Karolinska Institutet and Stockholm County Council work with a focus to achieve common objectives by sharing leadership responsibility and a strong commitment.


The healthcare system is facing major challenges. Statistics Sweden estimates that Sweden’s population will exceed 10 million by the year 2017 and reach 11 million by 2037. Sweden’s ageing population is another challenge for health and social services. Because people live longer, the incidence of age-related diseases will increase. Many healthcare workers are approaching retirement age, which may lead to a shortage of personnel. The situation requires a concerted action by the healthcare system and the development of preventive interventions, healthcare services and clinical research.

Knowledge based on research and evidence-based models

Today’s patients are more knowledgeable and well-informed, with many people taking more responsibility for their own health. It is increasingly common for people to seek out information on diseases in preparation for their healthcare visits.

In these circumstances it is important that people have access to research-based knowledge.One crucial task is therefore the creation of evidence-based models for prevention, diagnostics, treatment and the follow-up of results and treatment outcomes. Individuals can contribute to the information pool by, for instance, consenting to have their samples saved in biobanks and used in research. This enables the development of new diagnostic and treatment methods based on analyses of health data, tissues and blood.

Unique conditions

Sweden is unique in its long history of storing patient data in healthcare data bases and registers that are used in research. There are now also quality registers for patient data which, like the healthcare data bases, can be linked to biobank samples. This is a significant opportunity that can drive development – in Sweden as well as internationally.