Doctors aren't alone in grappling with these challenges, researchers say. According to the study, large employers and policymakers are also struggling to understand which measures are most appropriate for their quality initiatives. Ideas proposed by the authors for reconciling different quality measures include: development of a "comprehensive'' measure set, which would focus on measuring indicators that are most significant for diabetes care, such as glucose, blood lipids, and blood pressure; and use of a "composite score,'' that would combine a range of indicators and generate a single score.

"This study demonstrates that current measurement of diabetes care quality is far too complex and disjointed, and at the same time lacking in a number of key areas, particularly at the population level," says Dana Haza, senior director of NDCP.

The study also found significant gaps in quality measures, including a lack of population-based or epidemiologic measures. In addition, much of the current focus is on patients who are employed and insured, which ignores "millions of Americans and may not accurately reflect the overall state of diabetes care,'' the researchers write. Patient perspectives, access to care, or efforts to identify and advise those with pre-diabetes, those at high risk of developing the disease, are also not commonly measured.

The research was sponsored by the National Changing Diabetes?® Program, a diabetes leadership initiative established by Novo Nordisk to drive health systems change at the national and local level. About 24 million Americans have diabetes and health experts say that number could double in the next 20 years. With direct and indirect costs associated with diabetes and pre-diabetes estimated at $218 billion in the U.S. in 2007, much effort has gone into developing practice guidelines that improve care and patient outcomes.

"Streamlining and harmonizing existing measures is an important challenge that must be addressed to encourage wider use of performance assessment,'' the researchers conclude. Haza adds that a clearer understanding of the state of diabetes quality measurement is "an important step toward improving their usefulness, and addressing gaps in quality assessment.''

SOURCE National Changing Diabetes Program