title: Stakeholders' perspectives on quality indicators for diabetes care: a qualitative study.
abstract: BACKGROUND
  Transparency in diabetes care requires quality indicators that are of interest to stakeholders in order to optimise their usage. Indicator development is often focused on consensus, and little is known about stakeholders' preferences for information on quality.
  
  
  OBJECTIVE
  To explore the preferences of consumers, providers, purchasers and policy makers for different quality domains and indicators in relation to the intended use of quality indicators.
  
  
  METHODS
  Between June and December 2009, 14 semi-structured interviews were held with stakeholders  who have a decisive vote in the selection of the national indicator set for diabetes care in the Netherlands. The following subjects were explored: (1) the aims of using information on quality; (2) the interpretation of and preferences for the quality domains of safety, timeliness, effectiveness  and patient-centredness in relation to the user aims; and (3) the preferences for structure, process or outcome indicators. Content analysis was used to analyse qualitative data.
  
  
  RESULTS
  Stakeholders had similar and different aims according to their roles. The interpretations of  quality domains varied greatly between the stakeholders. Besides differences in interpretation, their preferences were similar. Most stakeholders prioritised patient-centredness above the other domains of quality, ranked in order of priority as safety, effectiveness and timeliness, whereas  purchasers also prioritised efficiency. All stakeholders preferred to use process indicators or a mix of process and outcome indicators.
  
  
  CONCLUSIONS
  The preferences of the stakeholders for quality indicators seem to be neither well-refined nor congruent. The implementation of an  indicator set can probably be improved if the stakeholders' definitions and preferences for quality domains become more explicit during the selection process for indicators.
authors.affiliation: IQ Scientific Institute for Quality of Healthcare (IQ healthcare), The Netherlands.
authors.forename: Joekie
authors.initials: J
authors.lastname: Markhorst
authors.forename: Liana
authors.initials: L
authors.lastname: Martirosyan
authors.forename: Hiske
authors.initials: H
authors.lastname: Calsbeek
authors.forename: Jozé
authors.initials: J
authors.lastname: Braspenning
mesh_terms: D000288:Administrative Personnel; D003920:Diabetes Mellitus / Q000628:therapy*; D006282:Health Personnel; D006801:Humans; D057240:Patient Preference; D061214:Patient Safety; D036301:Qualitative Research; D019984:Quality Indicators, Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration; D013997:Time Factors