Quality indicators for type-2 diabetes care in practice guidelines: an example from six European countries.
BACKGROUND
Diabetes mellitus patients need a multidisciplinary management and rigorous follow up. Quality indicators are important to assess and improve the quality of the health-care delivery. Less straightforward, however, is choosing which indicators to use for the assessment of the disease management.


METHODS
Review of guidelines. Process and outcome indicators were extracted out of type-2 diabetes guidelines from Belgium and its neighbouring countries. The "most evidence based" indicators were derived after applying a "best evidence" ratio.


RESULTS
Thirty-four indicators were classified in five diabetes management topics: (1) control of glycaemia, (2) early detection of glycaemic complications, (3) treatment of glycaemic complications, (4) cardiovascular disease and, (5) quality of life. Target values to outcome indicators and appropriate specifications to process indicators were not assigned because direct transfer to different countries is not possible without considering contextual information such as typical preconditions of every society and health-care system.


CONCLUSIONS
Although not all aspects of care are described in guidelines, five 'mini' lists of highly valuable indicators for optimal treatment in the field of type-2 diabetes could be drawn up. The target sets for indicators' values and specifications are a matter of ongoing concern because evidence changes over time.
Wens
Johan
J
University of Antwerp, Faculty of Medicine, Department of General Practice, Integrated Health Care and Geriatrics, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium. johan.wens@ua.ac.be
Dirven
Kristien
K
Mathieu
Chantal
C
Paulus
Dominique
D
Van Royen
Paul
P
D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D019468:Disease Management; D005060:Europe; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000145:classification*