Open Access Study protocol

Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study

Marjo JE Campmans-Kuijpers1*, Lidwien C Lemmens2, Caroline A Baan2, Kees J Gorter1, Jolanda Groothuis3, Klementine H van Vuure3 and Guy EHM Rutten1

Author Affiliations

1 Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Heidelberglaan 100, 3508, GA Utrecht, The Netherlands

2 Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721, MA Bilthoven, The Netherlands

3 Knowledge Centre for Shared Care, Dr Spanjaardsweg 11, 8000, GK Zwolle, The Netherlands

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BMC Health Services Research 2013, 13:129  doi:10.1186/1472-6963-13-129

Published: 5 April 2013



Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support.


This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire.


This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries as well.

Type 2 diabetes; Quality management; Quality improvement; Care groups; Outpatient clinics; Questionnaire; Integrated care; Shared care; Disease management