1st Annual EUBIROD meeting

Dasman Center for Research and Treatment of Diabetes, Kuwait City

Kuwait City, Kuwait, 2nd-4th May 2009

Evidence-base for EU diabetes information

Fred Storms, CBO, Netherlands

First BIRO Academy Residential Course, Kuwait City, Kuwait, 2nd May 2009


The BIRO project proposes the creation of a Shared “Evidence-Based” Diabetes Information System to support European health policy. The essential items to be collected must be continuously revised, taking into account the actual relevance of new knowledge on diabetes for population health and everyday practice.

In this presentation, Dr. Fred Storms, a clinical diabetologist from CBO, Netherlands, presents the aim and contents of the clinical review conducted by Joanneum Research for the BIRO Consortium. Fred introduces the main results and how they have been summarized into indicators that were used to propose a set of relevant measures to be collected routinely for benchmarking of diabetes prevention and care across Europe.

In a first step existing guidelines were viewed. Comments, literature references and potentially interesting data items were extracted and clustered per thematic area. Fred explains how a data item per definition is considered as being “one single piece of data” or “the smallest piece of information that can be obtained from a survey or census”. Several new or modified items were suggested by the review. In a second step indicators were defined, whereby indicators are seen as “a measure used to determine, over time, performance of functions, processes, and outcomes“. The selection of indicators was carried out along the recommendations for indicator evaluation developed by the US Institutes of Medicine and applied by the OECD Quality Indicators Project. According to this approach, indicators have to be relevant, secondly, they have to be scientifically sound, and thirdly, they have to be potentially feasible. In a third step the indicators were rated according to the above mentioned scheme in a consensus process within the consortium.

Dr. Storms, as a former coordinator of the EUCID project, explains how he is interested in the feasibility component, as it frequently happens that such indicators are hard to collect, particularly at national level. As a matter of fact, out of N=85 candidate indicators initially suggested, only N=49 were finally selected as being relevant for BIRO. The level of feasibility was taken into account when defining the data items required for computing such indicators. As a result of the clinical review, a key list of BIRO indicators were selected, then divided for convenience into specific chapters: epidemiology, structural quality, process quality, intermediate outcomes and terminal outcomes. More details on these indicators are included in the report template section of the project.

Fred concludes his presentation by remarking that the set of indicators herein described as candidate for inclusion in the BIRO system needs to be carefully assessed after a “BIRO core data set” is implemented in real life conditions, to be duly maintained by all participating regions and eventually democratically expanded.

One of the problems remains the necessary continuous update of this revision, which is natural due to the constant evolution of care processes and the data itself along time.