Evidence-based interventions for identifying candidate quality indicators to assess quality of care in diabetic foot clinics: a scoping review

TL;DR

This study identifies 42 candidate quality indicators for diabetic foot care using an evidence-based approach to improve care quality.

Contribution

The study introduces a formal, evidence-based methodology to develop quality indicators for diabetic foot clinics.

Findings

A total of 42 candidate quality indicators were formulated from 322 clinical studies.

Candidate indicators span domains like wound healing, peripheral artery disease, and care organization.

Feasibility of the indicators will be evaluated by a multidisciplinary panel.

Abstract

Foot ulcers in people with diabetes are a serious complication requiring a complex management and have a high societal impact. Quality monitoring systems to optimize diabetic foot care exist, but a formal and more evidence-based approach to develop quality indicators (QIs) is lacking. We aimed to identify a set of candidate indicators for diabetic foot care by adopting an evidence-based methodology.

A systematic search was conducted across four academic databases: PubMed, Embase CINAHL and Cochrane Library. Studies that reported evidence-based interventions related to organization or delivery of diabetic foot care were searched. Data from the eligible studies were summarized and used to formulate process and structure indicators. The evidence for each candidate QI was described in a methodical and transparent manner. The review process was reported according to the “Preferred Reported Items for Systematic reviews and Meta-Analysis” (PRISMA) statements and its extension for scoping reviews.

In total, 981 full-text articles were screened, and 322 clinical studies were used to formulate 42 candidate QIs.

An evidence-based approach could be used to select candidate indicators for diabetic foot ulcer care, relating to the following domains: wound healing interventions, peripheral artery disease, offloading, secondary prevention, and interventions related to organization of care. In a further step, the feasibility of the identified set of indicators will be assessed by a multidisciplinary panel of diabetic foot care stakeholders.

The online version contains supplementary material available at 10.1186/s12889-024-18306-2.

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