title: Perioperative diabetes care: development and validation of quality indicators throughout the entire hospital care pathway.
abstract: In this study, we aim to develop a set of quality indicators for optimal perioperative diabetes care throughout the hospital care pathway and to gain insight into the feasibility of the indicator set in daily clinical practice by assessing the clinimetric properties of the indicators in a practice test.
  
  
  
  A literature-based modified Delphi method was used to develop a set of quality indicators. To assess clinimetric properties of each indicator (measurability, applicability, reliability, improvement potential and case-mix stability), a practice test was performed in six Dutch hospitals using a sample of 389 major surgery patients with diabetes who underwent abdominal, cardiac or large joint orthopaedic surgery.
  
  
  
  We developed a set of 36 quality indicators for perioperative diabetes care. The practice test showed that one indicator was inapplicable, and nine indicators were unmeasurable. Interobserver reliability was good (0.61≤k≤0.8) for all indicators except for one with moderate (0.41≤k≤0.6) interobserver reliability. Improvement potential was low (<10%) for five indicators. Twenty-one indicators, including three outcome indicators, nine process indicators and nine structure indicators, could be used to assess the quality of care delivered in our six study hospitals.
  
  
  
  We developed a face and content valid set of quality indicators for optimal perioperative diabetes care throughout the hospital care pathway, using a rigorous and systematic approach. The results from our practice test show that it is essential to subject indicators to a practice test before applying them for quality improvement purposes.
  
  
  
  ClinicalTrials.gov: NCT01610674.
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Hommel
authors.affiliation: Department of General Internal Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
authors.forename: Petra J
authors.initials: PJ
authors.lastname: van Gurp
authors.affiliation: Department of General Internal Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
authors.forename: Cees J
authors.initials: CJ
authors.lastname: Tack
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
authors.forename: Marlies Ejl
authors.initials: ME
authors.lastname: Hulscher
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D019091:Critical Pathways / Q000592:standards; D003697:Delphi Technique; D048909:Diabetes Complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000592:standards*; D059035:Perioperative Period; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D013514:Surgical Procedures, Operative / Q000379:methods*
chemical_list: D001786:Blood Glucose
keywords: Diabetes mellitus; Hospital medicine; Performance measures; Quality measurement; Surgery