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Table 1 Results from evaluation of candidate indicators

From: Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico

Indicator Validity Feasibility Result of the validation process Programmable in the EHR
I. Process indicators Average   
A. Timely detection of T2D complications and comorbidity in the last year     
1. At least one measurement of HbA1c 8.7 7.8 Accepted Programmable
2. Comprehensive foot evaluation 8.7 8.2 Accepted Programmable
3. Referral to the ophthalmologist 8.3 7.7 Accepted Programmable
4. Screening for microalbuminuria through the ratio albumin/creatinine 8.5 5.7 Discarded  
5. Measurement of creatinine and rate of glomerular filtration 8.7 5.3 Discarded  
6. Screening for dyslipidemia by measuring total cholesterol in patients without previous diagnosis of dyslipidemia 8.5 7.8 Accepted Programmable
B. Non pharmacological treatment in the last year     
7. Smoking cessation counseling for current smokers 8.2 8 Accepted Not Programmable
8. Advise to moderate alcohol consumption 6.0 5.8 Discarded  
9. Nutritional counseling provided by the nutrition service 7.8 7.8 Accepted Programmable
10. Advise to practice aerobic physical exercise of moderate intensity, at least 150 minutes per week, unless contraindicated 8.2 8.0 Accepted Not Programmable
11. Registration of adherence to dietary recommendations 8.5 7.0 Accepted Not Programmable
12. Registration of adherence to aerobic physical exercise 8.5 7.0 Accepted Not Programmable
C. Pharmacological treatment in the last three visits     
13. Overweight/obese (BMI ≥ 25 kg/m2) patients who received metformin, unless contraindicated* 8.7 8.5 Accepted Programmable
14. Patients with HbA1c ≥ 8, or with an average fasting blood glucose of ≥140 mg/dl in the last 3 months, who had registered: a) recommendations to modify their diet and physical exercise, b) referral to a social work group; c) modification in their scheme of treatment. 8.7 6.3 Discarded  
15. Patients with HbA1c ≥ 8, or with an average fasting blood glucose of ≥140 mg/dl in the last 3 months, who had registered adherence to the pharmacological treatment. 8.5 6.8 Discarded  
16. Patients with hypertension receiving inhibitors of angiotensin converting enzyme or angiotensin-receptor blocker, otherwise contraindicated** 8.5 8.5 Accepted Programmable
17. Patients > 40 years of age with one or more of the following risk factors: smoking, hypertension, dyslipidemia, receiving 75-150 mg/day of acetylsalicylic acid, unless contraindicated*** 8.5 8.2 Accepted Programmable
18. Patient with total cholesterol >200 mg/dl and were prescribed statins, unless contraindicated**** 8.2 8.3 Accepted Programmable
II. Health outcomes indicators     
19. HbA1c <7% or fasting glucose ≤130 mg/dl in the last 3 measurements 8. 7 8.3 Accepted Programmable
20. Total cholesterol levels < 200 mg/dl in the last measurement 8. 7 8.2 Accepted Programmable
21. Blood pressure <130/80 mmHg in the last 3 measurements 8. 7 8.5 Accepted Programmable
22. Overweight/obese (BMI ≥ 25 kg/m2) patients who lost ≥5% body weight in the last year 8.0 7. 7 Accepted Programmable
Composed indicator of health outcomes     
23. Patients with HbA1c <7%, or fasting glucose ≤130 mg/dl, total cholesterol levels < 200 mg/dl and blood pressure <130/80 mmHg in the last 3 measurements 8.5 7.5 Accepted Programmable
  1. *Contraindications to metformin: a) Renal failure b) respiratory or advanced liver failure c) congestive heart failure, coronary artery disease or advanced atherosclerosis; d) pregnancy; e) intolerance to metformin.
  2. **Contraindications to inhibitors of angiotensin converting enzyme: intolerance and/or prior treatment failure.
  3. ***Contraindications to acetylsalicylic acid in doses of 75-150 mg/day: history of hypersensitivity to aspirin, peptic ulcer disease, and hemophilia.
  4. ****Contraindications to statins: hypersensitivity to any component of the drug, active liver disease or unexplained persistent elevations of serum transaminases, pregnancy and lactation.
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