title: Review: relation between quality-of-care indicators for diabetes and patient outcomes: a systematic literature review.
abstract: The authors conducted a systematic literature review to assess whether quality indicators for diabetes care are related to patient outcomes. Twenty-four studies were included that formally tested this relationship. Quality indicators focusing on structure or processes of care were included. Descriptive analyses were conducted on the associations found, differentiating for study quality and level of analysis. Structure indicators were mostly tested in studies with weak designs, showing no associations with surrogate outcomes or mixed results. Process indicators focusing on intensification of drug treatment were significantly associated with better surrogate outcomes in three high-quality studies. Process indicators measuring numbers of tests or visits conducted showed mostly negative results in four high-quality studies on surrogate and hard outcomes. Studies performed on different levels of analysis and studies of lower quality gave similar results. For many widely used quality indicators, there is insufficient evidence that they are predictive of better patient outcomes.
authors.affiliation: University Medical Center Groningen, University of Groningen, the Netherlands.
authors.forename: Grigory
authors.initials: G
authors.lastname: Sidorenkov
authors.forename: Flora M
authors.initials: FM
authors.lastname: Haaijer-Ruskamp
authors.forename: Dick
authors.initials: D
authors.lastname: de Zeeuw
authors.forename: Henk
authors.initials: H
authors.lastname: Bilo
authors.forename: Petra
authors.initials: P
authors.lastname: Denig
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D007558:Italy; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D006113:United Kingdom; D014481:United States