Development of a minimal set of prescribing quality indicators for diabetes management on a general practice level

Objective To identify the relevant prescribing quality domains of type 2 diabetes mellitus care as a basis for the selection of a minimal set of prescribing quality indicators from a set of previously validated indicators. Methods We used the principal factor analysis to identify the underlying dimensions or domains of prescribing quality for 76 general practitioners participating to the Groningen Initiative to Analyse Type 2 Diabetes Treatment project in the Netherlands. From a set of 10 prescribing quality indicators covering various aspects of cardiovascular and metabolic management, we selected a subset of indicators with the highest loading within each identified domain. Next, we evaluated the effect of using this subset on the quintile ranking of practices on their prescribing quality scores. Results We identified five prescribing quality domains in our data set: two assessing initiation of pharmacotherapy for different risk factors in diabetic patients, two on stepwise intensification of treatment, and one on treatment of patients with cardiovascular disease. A composite score comprising the indicators selected from each of the domains showed good agreement with the composite score comprising all indicators with 82% of general practitioners either not changing their position or shifting their ranking by only one quintile. Conclusions We showed that a minimal set of prescribing quality indicators for type 2 diabetes mellitus care should not just focus on the management of different clinical risk factors but also reflect different steps of treatment intensification. The results of our study are relevant for stakeholders when selecting quality indicators to assess the quality of prescribing in diabetic patients. Copyright (C) 2011 John Wiley & Sons, Ltd.