title: Performance measurements in diabetes care: the complex task of selecting quality indicators.
abstract: OBJECTIVE
  To review the literature on the content and development of the sets of quality indicators used in studies on the quality of diabetes care in primary care settings.
  
  
  METHODS
  The MEDLINE (Ovid), PubMed, PsychINFO, Embase and CINAHL databases were searched for relevant articles published up to January 2011.
  
  
  METHODS
  and data extraction We included studies on the quality of adult diabetes care, using quality indicators. We excluded studies focusing on the hospital setting, patient subgroups, specific components of diabetes care and specific outcomes. In total, 102 studies (including 102 sets and 1494 indicators) were analyzed by two independent reviewers, using the criteria of the National Quality Measures Clearinghouse and international guidelines to document the content and selection of the identified indicators.
  
  
  RESULTS
  Sets varied greatly in number, content and definitions of quality indicators. Most of the indicators concerned HbA1C, lipids, blood pressure, eye and foot examination and urinalysis. Few sets included indicators on lifestyle counseling, patient experiences, healthcare structure or access to healthcare providers. Seventy sets did not specify explicit selection criteria, and 19 of these did not report the sources of the indicators.
  
  
  CONCLUSIONS
  Sets of quality indicators are diverse in number, content and definitions. This diversity reflects a lack of uniformity in the concept of diabetes care quality and hinders the interpretation of and comparison between quality assessments. Methodology regarding defining constructs such as the quality of diabetes care and indicator selection procedures is available and should be used more rigorously.
authors.affiliation: Radboud University Medical Center, PO Box 9101, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands. hiske.calsbeek@radboudumc.nl.
authors.forename: Hiske
authors.initials: H
authors.lastname: Calsbeek
authors.forename: Nicole A B M
authors.initials: NA
authors.lastname: Ketelaar
authors.forename: Marjan J
authors.initials: MJ
authors.lastname: Faber
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Jozé
authors.initials: J
authors.lastname: Braspenning
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D011320:Primary Health Care / Q000592:standards; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000592:standards
keywords: diabetes mellitus; indicators; primary care; quality of care; systematic review