Learning Objective #1: know how to develop a measurement related to quality of care.

Learning Objective #2: to understand quality of diabetes care and the professional performance.

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Process is one of important factors for quality of care. Studies showed inconsistency between professional performance and recommendations for diabetes care. This paper was to present the development of Diabetes Professional Performance Measurement (DPPM), which includes preventive monitoring (M-DPPM) and diabetes self-management education (E-DPPM).

Based on the diabetes care guidelines leased from Taiwan Bureau of National Health Insurance (BNHI) and the measures employed for the study of diabetes adult patients in the Diabetes Quality Improvement Program sponsored by ADA, the investigator used a panel of experts to select appropriate items and subscores for measuring diabetes professional performance. Seven dimensions of preventive monitoring were selected. Risk factors of diabetes complications were measured through evaluation of blood tests for A1C, blood glucose, nephropathy assessment (serum creatinine, urine protein, and microalbumin), lipid profile (total cholesterol, LDL-C, HDL-C, and triglyceride), blood pressure check-up frequency, foot examination, and ophthalmoscopic examination. The potential subtotal maximum score for each dimension is 10 points. The maximum score for M-DPPM is 70 points.

Five dimensions make up the assessment of diabetes self-management education performance: tobacco status and counseling (10 points), diet education (10 points), exercise education (10 points), instructions about foot care (10 points), and instruction about self-monitoring of blood glucose (10 points). The potential maximum subtotal score for E-DPPM is 50 points. The higher the score, the higher is the performance.

Data of M-DPPM and E-DPPM were collected from a review of patient medical records and the patients' self-report respectively. Internal consistency was examined with Cronbah's alpha coefficient, which for the DPPM, M-DPPM, and E-DPPM were .71, .74, and .61, respectively (N=140). The percentages of inter-rater and intra-rater agreement were 93.1% and 92.5%, respectively. The DPPM was also investigated its correlations with diabetes self-care activities and presented as an important indicator for quality of care.