Worldwide, the number of type 2 diabetes mellitus patients (T2DM) is rising rapidly . This poses great challenges to cost, efficacy and quality of diabetes care. Diabetes care usually involves many health care providers. Consequently, optimal collaboration and coordination among professionals has become essential for delivering high quality of care ; in addition, this care should be organised in a patient centred way . Organisations providing diabetes care are obliged to control these complex processes by quality management (QM). QM comprises procedures to monitor, assess and improve the quality of care . Besides focussing on patient related and process outcomes, also other aspects of QM on an organisational level are likely to become crucial in order to maintain or enhance the delivery of good quality diabetes care .
In the Netherlands, patients with type 2 diabetes are in principle treated in primary care. Patients, who need more complex care, are treated in secondary care . In primary care, most patients (80-85%) are treated within so called diabetes care groups (DCGs) . These DCGs, comparable with Accountable Care Organizations (ACOs) [8, 9] in the United States and Clinical Commission Groups (CCGs)  in the United Kingdom, emerged after the introduction of bundled payment in 2007 . DCGs are the main contractor of a diabetes care program, and are responsible for the organisation, coordination and delivery of diabetes care. They comprise between three and 250 general practitioners (GPs) . The diabetes care program is based on the Dutch Diabetes Federation Health Care Standard (DFHCS) for T2DM . Patients who need more complex diabetes care are treated in 104 diabetes outpatient clinics (DOCs). Besides the DFHCS standard, the latter have special guidelines for treatment of a diabetic foot, retinopathy, nephropathy [6, 14].
The organisation of DCGs  and DOCs  varies widely. In DOCs the organisation is managed by the hospital department itself, although the endocrinologist is mainly responsible for the quality of diabetes care. In the DCGs, managers, managing directors or GPs are in charge of a whole care group; their type of organisation varies with regard to the type of legal entity, the ownership of the care group and the number of employees . Also the number of patients treated in both DCGs (400–22,500)  and DOCs (250–4,500) varies widely. Both DCGs and DOCs strive to deliver good quality of care for type 2 diabetes patients. Very recently, Tricco et al. (2012) stated that targeting the system in chronic care management is important in improving diabetes care . So far, little attention has been paid to QM on an organisational level. Therefore, this study focuses on improving quality of diabetes care at an organisational level by improving QM.
First, we want to study the current level of QM in all DCGs and DOCs in the Netherlands. Based on the baseline measurement participating organisations will be given feedback; this will show them their strengths and weaknesses in QM. Next, they will be provided access to a toolbox for QM and offered the possibility of tailored support. After one year we will examine their level of QM again.
In this paper we describe the study design and the operationalisation of QM and the questionnaire used to measure QM.