Quality Measurement in Diabetes Care

Abstract

This study aimed to evaluate diabetes quality measurement efforts, assess their strengths and areas for improvement, and identify gaps not adequately addressed by these measures. We conducted an environmental scan of diabetes quality measures, focusing on metrics included in the National Quality Measures Clearinghouse or promulgated by leading measurement organizations. Key informant interviews were also completed with thought leaders who develop, promote, and use quality measures. The environmental scan identified 146 distinct measures spanning 31 clinical processes or outcomes. This suggests a measurement system that is both redundant and inconsistent, with many different measures assessing the same clinical indicators. Interviewees believe that current diabetes measurement efforts are excessively broad and complex and expressed a need for better harmonization of these measures. Several gaps were also found, including a lack of measures focusing on population health, structural elements of health care, and prevention of diabetes.

Breakout Session: Ethnic and Gender Differences in Diabetic Foot Management and Amputations

“…The wide range of findings and conclusions from multiple studies on ethnic and gender differences in diabetic foot management and amputations support our conclusion that there currently exists no reliable large dataset to study this problem [7,13,24,29]. Most studies rely on administrative datasets or are based on a single coding system.…”

“…The role of women as a subpopulation susceptible to healthcare discrepancies has recently been studied with similar results [5,[25][26][27]30]. Many advocate future studies of subgroup-specific interventions with consideration of all contributing factors [7,13,19,25,29]. A breakout session in the 2010 The AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium met to define and outline gender and ethnic musculoskeletal healthcare disparities in diabetic foot management and amputation.…”

Redesign of a Diabetes System of Care Using an All-or-None Diabetes Bundle to Build Teamwork and Improve Intermediate Outcomes

“…There are at least 146 distinct measures in diabetes care, 13 and the way they are combined can have profound differences on the results. 14 The components that one organization would find most beneficial could be different from the components selected by another organization in a different stage of the improvement process.…”

Do we need individualised prescribing quality assessment? The case of diabetes treatment

“…Patient perspectives or preferences are seldom included in quality assessment, since these are rarely documented in administrative or medical databases [3]. Within the system for performance management and payment of general practitioners (GPs) in the UK (QOF) [2], GPs can explicitly exclude individual patients from individual quality indicators.…”

“…Worldwide, a large number of prescribing indicators has been developed to assess treatment quality. For example, within the area of diabetes and cardiovascular risk management, hundreds of indicators were identified [3,4]. They measure various aspects of prescribing, including timely prescribing, preferred drug choice, drugs to be avoided, adequate dosing, and monitoring (Table 1).…”