Performance/outcome measures for area health board diabetes services.
OBJECTIVE
to examine the validity of performance indicators nominated by the Department of Health for area health board diabetes services for 1990-91.


METHODS
by examination of admission/discharge data for the Otago region for the years 1985-9, together with a survey of randomly chosen clinical notes to quantify errors in the admission/discharge database.


RESULTS
of the proposed indicators, there is marked variation in statistical significance, primarily as a consequence of the often small number of numerator events and denominator populations involved. Further the rates and statistical significance vary markedly depending on the interpretation of the numerator events to be included. Diabetes as the principal diagnosis was correctly recorded in 100% of notes examined. Of these the clinical diagnosis was incorrectly described in the discharge summary in 2% of cases. In 46% of cases where diabetes should have been recorded as a subsidiary diagnosis, it was not.


CONCLUSIONS
the potential exists for significant misinterpretation of these indicators with the proposed data sources. Using routinely collected data there are potentially more robust indicators applicable for use at an area health board level. Much work needs to be done if these indicators are to truly reflect all facets of the performance of a diabetes service.
Phillips
D E
DE
University of Otago, Dunedin.
Mann
J I
JI
D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D003951:Diagnostic Errors; D006751:Hospital Information Systems; D006801:Humans; D008499:Medical Records; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011897:Random Allocation; D012189:Retrospective Studies