Development of clinical indicators for type 2 diabetes

Background/Objective: Preventable drug-related morbidity in patients with type 2 diabetes is a major concern. Our objective was to develop a set of Canadian clinical indicators of preventable drug-related morbidity (PDRM) and preventable care-related morbidity (PCRM) for type 2 diabetes. Methods: Each study partner (Dalhousie University, Nova Scotia Department of Health, Diabetes Care Program of Nova Scotia, and Sobeys Pharmacy Group) was asked to identify the priorities of medication-related diabetes care from the Canadian Diabetes Association 2003 clinical practice guidelines using the nominal group technique. Based on the priorities identified, a survey was constructed listing the clinical outcome and pattern of care related to a number of possible PDRMs/PCRMs in patients with type 2 diabetes. Using the Delphi technique, an interdisciplinary panel of 10 experts scored each clinical indicator in an attempt to achieve consensus. Results: Education/reinforcement of targets was identified by the nominal group technique as the most important area in which to improve diabetes care. After 3 rounds of the Delphi technique, 21 consensus-based clinical indicators were generated. Nine indicators were on the initial survey in round 1, and 12 indicators were suggested by the expert panel in rounds 1 and 2. Discussion: The resulting 21 clinical indicators provide clinicians and decision-makers with valuable tools to measure the quality of medication use in patients with type 2 diabetes.