title: Diabetic retinopathy care--an international quality comparison.
abstract: OBJECTIVE
  The purpose of this paper is to study the quality indicator appropriateness and use it for international quality comparison on diabetic retinopathy (DR) patient care process in one American and one Dutch eye hospital.
  
  
  METHODS
  A 17-item DR quality indicator set was composed based on a literature review and systematically applied in two hospitals. Qualitative analysis entailed document study and 12 semi-structured face-to-face interviews with ophthalmologists, managers, and board members of the two hospitals.
  
  
  RESULTS
  While the medical-clinical approach to DR treatment in both hospitals was similar, differences were found in quality of care perception and operationalization. Neither hospital systematically used outcome indicators for DR care. On the process level, the authors found larger differences. Similarities and differences were found in the structure of both hospitals. The hospitals' particular contexts influenced the interpretation and use of quality indicators.
  
  
  CONCLUSIONS
  Although quality indicators and quality comparison between hospitals are increasingly used in international settings, important local differences influence their application. Context should be taken into account. Since that context is locally bound and directly linked to hospital setting, caution should be used interpreting the results of quality comparison studies.
  
  
  CONCLUSIONS
  International quality comparison is increasingly suggested as a useful way to improve healthcare. Little is known, however, about the appropriateness and use of quality indicators in local hospital care practices.
authors: Carolina Elisabeth
authors: CE
authors: de Korte
authors: Dirk F
authors: DF
authors: de Korne
authors: Jose P
authors: JP
authors: Martinez Ciriano
authors: J Robert
authors: JR
authors: Rosenthal
authors: Kees
authors: K
authors: Sol
authors: Niek S
authors: NS
authors: Klazinga
authors: Roland A
authors: RA
authors: Bal
mesh_terms: D003930:Diabetic Retinopathy / Q000628:therapy*; D017598:Efficiency, Organizational; D006782:Hospitals, Special / Q000458:organization & administration*; D006801:Humans; D038622:Internationality; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*; D015203:Reproducibility of Results; D014481:United States