Selecting indicators for the quality of diabetes care at the health systems level in OECD countries

Purpose. In the context of the Organization for Economic Cooperation and Development (OECD) Quality Indicators Project, a set of quality indicators for diabetes care was developed, to be used for benchmarking the performance of health care systems. Background. Diabetes complications markedly reduce quality and length of life and are also responsible for enormous health care costs. A large body of evidence has shown that several effective treatments and practices may substantially reduce this burden. However, a marked variability has been documented in preventive and therapeutic approaches, thus suggesting that the level of diabetes care currently delivered may not produce the possible health-related gains. Methods. Existing quality indicators have been reviewed, with particular attention to the work done by the National Diabetes Quality Improvement Alliance ( NDQIA) in the US. All the measures identified were evaluated for their importance, scientific soundness, and feasibility. In addition, the panel members selected new distal outcome measures. These measures are currently not used in provider comparisons, but they could reveal valuable insight into the differential performance of health systems. Results. Four process and two proximal outcome measures were selected among those endorsed by the NDQIA. In addition, three new long-term outcome measures have been proposed to gain insight into whether and to what degree differences in the processes and intermediate outcomes that are captured by the established measures translate into better outcomes for patients. Conclusions. The measures selected can contribute to policymakers' and researchers' understanding of differences in the quality of diabetes care between health systems. Further work is required to assess the availability of reliable and comparable data across OECD countries.