Defining Quality Care

Objective of Section

To define quality in diabetes care and provide information on current diabetes-specific programs to improve care, which are often coupled with financial incentives.


The quality of health care in the United States was the focus of the Institute of Medicine (IOM) report “To Err Is Human.” The report focused on medical errors occurring in U.S. hospitals, causing as many as 100,000 deaths per year, and a failing health care delivery system that was poorly organized around quality, leading to poor results. In 2001, the IOM published “Crossing the Quality Chasm,” a document that attempts to define quality of care and provides a structure to improve the performance of the health care system. The efforts to improve quality in the U.S. health care system have resulted in marginal results. The most recent report on hospital-based deaths due to medical errors places the number at 440,000 per year, the third leading cause of death in the United States.2

The focus on diabetes metrics as it relates to quality pre-dates the IOM reports. The National Committee for Quality Assurance and the Healthcare Effectiveness Data and Information Set (HEDIS)3 was developed when “managed care” was introduced during the Clinton administration. HEDIS was the first national program that captured diabetes-related metrics. In 1997, the first diabetes-specific measures were developed as part of the Diabetes Quality Improvement Project.4 Since 2000, a number of national organizations, private insurers, government organizations, and academicians have advanced system changes and developed guidelines and metrics to improve diabetes care.

This section covers the structure and types of measures currently used in diabetes care. In addition, there is a brief discussion of current programs, including the Medicare Physician Quality Reporting System (PQRS),5 HEDIS measures for diabetes,6 Patient Centered Medical Home,7 ambulatory care sensitive admissions, and hospital-acquired conditions (HAC).8

The current status of the literature of diabetes care and the evolving field of measuring quality are presented. There are now thousands of metrics that are linked to measures of quality or value. Quality is increasingly being measured by outcomes, whether it is a 30-day readmission rate or an estimate of a person’s 10-year mortality risk. With advanced technology, the quality and quantity of data are improving to allow better ways to measure quality. Some of these changes are currently being incorporated into quality measures.