• Geetha Mukerji, Ilana Halperin, Katie Hunter, Phillip Segal, Maria Wolfs, Lindsay Bevan, Lianne Jeffs, and Jeannette Goguen.
• Women's College Hospital, 76 Grenville St, Toronto, Ontario M5S 1B2, Canada.
• Int J Qual Health Care. 2018 Feb 1; 30 (1): 65-74.

ObjectiveThere is a large evidence to practice gap in diabetes care with limited performance assessments that capture the full spectrum of care delivery. Our study aimed to develop a set of ambulatory diabetes quality indicators across six domains (effectiveness, safety, patient-centered, timely, equitable and efficient) to provide a broad view of quality.DesignA modified Delphi panel process was conducted. Phase I involved compiling a list of indicators through literature review and generation of patient and healthcare provider-derived indicators through interviews and surveys, respectively. Phase II involved panelists rating indicators using the Agency for Healthcare Research and Quality measure attributes on 9-point Likert scale, attending a face-to-face meeting followed by re-rating, and final ranking.SettingThis study was conducted across five adult academic medical centers affiliated with the University of Toronto.ParticipantsA multi-disciplinary Delphi panel (n = 16) including patients was assembled.Main Outcome MeasureFor indicator advancement for ranking, ≥75% of panelists' responses in the top tertile (between 7 and 9) with a median composite score of ≥7 was required.ResultsThere were 202 indicators included in the Delphi panel process including 171 from a comprehensive literature review, 14 from patient interviews, and 17 from healthcare provider surveys. Following the first round, 40 indicators proceeded directly to ranking, while 162 indicators were re-rated and distilled down to 12 for ranking. In the final ranking round, the 52 indicators were reduced to 35 including 13 effective, 10 safe, 6 patient-centered, 1 equitable, 3 efficient and 2 timely indicators.ConclusionThirty-five selected indicators developed with broad stakeholder engagement can be used to monitor quality in diabetes care.© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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