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Perioperative diabetes care: development and validation of quality indicators throughout the entire hospital care pathway
  1. Inge Hommel1,
  2. Petra J van Gurp2,
  3. Cees J Tack2,
  4. Hub Wollersheim1,
  5. Marlies EJL Hulscher1
  1. 1Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
  2. 2Department of General Internal Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
  1. Correspondence to Inge Hommel, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, PO box 9101, Post 114, Nijmegen 6500 HB, The Netherlands; inge.hommel{at}radboudumc.nl

Abstract

Background 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.

Methods 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.

Results 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.

Conclusion 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.

Trial registration number ClinicalTrials.gov: NCT01610674.

  • Diabetes mellitus
  • Hospital medicine
  • Performance measures
  • Quality measurement
  • Surgery

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