INNOVATION FUND Technology and AI in Healthcare Quality and Safety SHOWCASE 2019

Developing a Balanced Scorecard for Quality in Diabetes Care

Quality and Safety

Phillip Segal


Toronto General Hospital, University Health Network, University of Toronto


MSH-15-011 An innovative project engaging both patients and health care providers to identify the key clinical, process and patient-reported outcomes that distinguish true quality diabetes care. Called the “Diabetes Scorecard” , this tool is currently being implemented in all the University of Toronto affiliated diabetes clinics and can easily be disseminated to other clinical programs. The Diabetes Scorecard will help facilitate knowledge transfer and collaborative efforts amongst all stakeholders to improve diabetes care across the broader healthcare system.


MSU-15-011 Current quality benchmarks in the field of diabetes focus largely on measures of effectiveness such as biological and process outcomes, and place little emphasis on other quality domains, particularly those that incorporate the patient experience. This has led to an evidence-to-practice gap in diabetes care with limited performance assessments that capture the full spectrum of care delivery. The aim of the current project is to address this gap by developing a set of ambulatory diabetes quality indicators that span the Institute of Medicine’s (IOM) six quality domains (effectiveness, safety, patient-centered, timely, equitable and efficient) in order to provide a broad view of quality. Preliminary indicators for our scorecard were chosen from extensive literature reviews, qualitative patient interviews and surveys. Then we used a modified Delphi process to synthesize quality benchmarks and finalize the scorecard. This was followed by one round of pilot testing to assess the quality and feasibility of data collection. We are currently focused on developing the necessary informatics infrastructure and fostering physician stakeholder engagement in order to sustain a reliable scorecard audit and feedback process at all University of Toronto diabetes clinics. This is the first attempt to benchmark and define “quality diabetes care” by incorporating patient narratives and perspectives into the development process. We hope that these patient-centered measures will become the standard by which diabetes care is assessed across the province of Ontario and eventually Canada.

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