Quality improvement initiatives: issues in moving from diabetes guidelines to policy.
OBJECTIVE
To outline the principles that direct the Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) dedicated to diabetes quality improvement (QUERI-DM).


METHODS
We discuss the VA initiatives aimed at improving diabetes care for veterans as well as general issues that should be considered in quality improvement initiatives. We specifically describe some of the epidemiological, statistical, and organizational issues that have guided our quality improvement (QI) programs.


RESULTS
The five principles that have guided the QUERI-DM process are: 1) treating clinical guidelines and goals distinct from quality standards and quality improvement priorities; 2) targeting high-risk patients and high-impact quality issues; 3) profiling processes over outcomes; 4) targeting processes that will improve patient outcomes; and 5) paying attention to the loci of practice variation.


CONCLUSIONS
The authors recommend that all five principles be considered when moving from practice guidelines to performance measures and QI initiatives. Targeting high-priority problems and high-risk groups can greatly improve the effectiveness and efficiency of QI interventions.
Hayward
Rodney A
RA
VA Center for Practice Management and Outcomes Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA. rod.hayward@med.va.gov
Hofer
Timothy P
TP
Kerr
Eve A
EA
Krein
Sarah L
SL
D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D010347:Patient Care Planning / Q000592:standards; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*