Monitoring of Diabetes Mellitus Patients

Identifying Attributes

Care Settings
Primary Care
Country
Estonia
Publishing Organisation
Family Physicians Quality System Indicators
Type of Quality Indicator
Process
IOM Quality Dimension
Effectiveness
Domain
Other Clinical

Defining Attributes

Definition

The percentage of type II diabetes mellitus patients whose; (1) glycohaemoglobin has been determined at least once a year (if the glycohaemoglobin is over (or equal to) 7.0%, the code on the treatment invoice should be 9050), (2) creatinine has been determined at least once a year, (3) total cholesterol content has been determined least once a year (if the patient has a total cholesterol value greater than 5.0 mmol/l, then regardless of the disease or condition, the code 9040 is always entered on the invoice); (4) cholesterol fractions have been determined at least once in 3 years, (5) who has been advised by the family nurse (lifestyle, control of the disease) at least once a year.

Numerator

The number of type II diabetes mellitus patients who have: (1) defined glycaemic haemoglobin, (2) defined creatinine in the blood serum, (3) defined total cholesterol in the blood serum, (4) defined cholesterol fractions in the blood serum, (5) counselling of the family nurse performed.

Denominator

All type II diabetic patients (ODC-10 code E11) who are on the current (reviewed) year in lists of chronic illnesses.

Exclusions

The following cases are excluded; if according to the population register, the person has left Estonia (lives abroad) or the corresponding diagnosis of chronic illness is on the treatment invoice only with the extension "0 - diagnosis unspecified".

Use of Risk Adjustment
No
Risk Adjustments
Stratifications

Collection and Reporting Attributes

Type of Data Collection
Standardised clinical data
Data Collection Methods

Estonian Health Insurance Fund database

Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Reporting Frequency
Reporting Frequency in Days
Indicator Has Recommended Targets
No

Source and Reference Attributes

Evidence Source

Merilind et al. Pay for performance of Estonian family doctors and impact of different practice- and patient-related characteristics on a good outcome: A quantitative assessment

Link to Measurement Tools
Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
No
Australian Consortium for Aged Care Endorsed
No
Identified by PHARMA-Care Project
No
Upload Date
04 November 2025