Stakeholders’ perspectives on quality indicators for diabetes care: a qualitative study

Markhorst, Joekie MSc
Martirosyan, Liana PhD
Calsbeek, Hiske RN PhD
Braspenning, Jozé PhD

Physical Therapist, Researcher, IQ Scientific Institute for Quality of Healthcare (IQ healthcare), The Netherlands
Physician, Health Researcher, NIVEL – Netherlands Institute for Health Services Research, Liana, The Netherlands
Registered Nurse, Researcher
Psychologist, Associate Professor
IQ Scientific Institute for Quality of Healthcare (IQ healthcare), The Netherlands

AUTHORS’ CONTRIBUTIONS

JM conducted the interviews, performed the qualitative analysis and interpretation of the data, and wrote the manuscript. LM participated in the interviews, contributed to the qualitative analysis and interpretation of the data, and reviewed the manuscript. HC contributed to the research questions, the interview guide, the discussion, and reviewed the manuscript. JB originated the study, contributed to the research questions and discussion, and reviewed the manuscript.

FUNDING

The Netherlands Organisation for Health Research and Development (ZonMw).

ETHICAL APPROVAL

Ethical approval is not necessary for interviews with healthcare professionals in the Netherlands.

PEER REVIEW

Not commissioned; externally peer reviewed.

CONFLICTS OF INTEREST

None.

ADDRESS FOR CORRESPONDENCE

Dr Jozé Braspenning, Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, IQ healthcare 114, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Tel: +31 24 3614937; email: [email protected]

Received 23 December 2011

Accepted 15 April 2012

Quality in Primary Care 20(4):p 253-261, 2012.

Background

Transparency in diabetes care requires quality indicators that are of interest to stakeholders in order to optimise their usage. Indicator development is often focused on consensus, and little is known about stakeholders’ preferences for information on quality.

Aim

To explore the preferences of consumers, providers, purchasers and policy makers for different quality domains and indicators in relation to the intended use of quality indicators.

Methods

Between June and December 2009, 14 semi-structured interviews were held with stakeholders who have a decisive vote in the selection of the national indicator set for diabetes care in the Netherlands. The following subjects were explored: (1) the aims of using information on quality; (2) the interpretation of and preferences for the quality domains of safety, timeliness, effectiveness and patient-centredness in relation to the user aims; and (3) the preferences for structure, process or outcome indicators. Content analysis was used to analyse qualitative data.

Results

Stakeholders had similar and different aims according to their roles. The interpretations of quality domains varied greatly between the stakeholders. Besides differences in interpretation, their preferences were similar. Most stakeholders prior-itised patient-centredness above the other domains of quality, ranked in order of priority as safety, effectiveness and timeliness, whereas purchasers also prioritised efficiency. All stakeholders preferred to use process indicators or a mix of process and outcome indicators.

Conclusions

The preferences of the stakeholders for quality indicators seem to be neither well-refined nor congruent. The implementation of an indicator set can probably be improved if the stakeholders’ definitions and preferences for quality domains become more explicit during the selection process for indicators.