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From Consensus Through Prioritization: A Delphi Method, Clinical Audit, and Analytic Hierarchy Process Framework for
Ansif Pallath Majeed1,2, Niyaz Panakaje3, Shajitha Thekke Veettil2
1Yenepoya (Deemed to Be University), Mangalore, Karnataka, India.
Journal of Primary Care & Community Health
|June 18, 2026
Summary
Primary care in Qatar shows gaps in preventive services for Type 2 diabetes mellitus (T2DM) management. A quality improvement framework using Delphi and Analytic Hierarchy Process (AHP) identified key areas for improvement in T2DM care.
Area of Science:
- Public Health
- Primary Care Medicine
- Diabetes Management
Background:
- Type 2 diabetes mellitus (T2DM) affects 17% of adults in Qatar, necessitating enhanced primary care management.
- Existing guidelines for T2DM care are not fully implemented, with deficits in preventive and patient-centered services.
- A structured, data-driven quality improvement (QI) framework was developed to address these care gaps.
Purpose of the Study:
- To implement and evaluate a QI framework for improving T2DM management in Qatari primary health care facilities.
- To identify and prioritize key performance indicators (KPIs) and intervention areas through expert consensus and data analysis.
Main Methods:
- A mixed-methods, pre-implementation QI study involving 31 primary health care facilities.
- Phase 1: Delphi consensus with 65 physicians to validate 17 KPIs for T2DM care.
- Phase 2: Retrospective audit of 450 T2DM patient records to assess KPI adherence.
- Phase 3: Analytic Hierarchy Process (AHP) to prioritize improvement interventions based on impact, feasibility, and urgency.
Main Results:
- Unanimous consensus was reached on all 17 KPIs by the Delphi panel.
- High adherence (∼82%) was observed for laboratory-based indicators, contrasting with low performance in preventive care (e.g., ASCVD risk assessment 19.6%, foot exams 24.0%).
- AHP identified ASCVD risk assessment, foot examinations, lifestyle education, follow-up HbA1c testing, and individualized HbA1c goal-setting as top priorities.
Conclusions:
- Significant deficits exist in preventive and patient-centered diabetes care within primary care settings.
- The Delphi-AHP framework provides a robust, evidence-based model for QI planning in T2DM management.
- A participatory approach involving clinicians enhances the credibility and feasibility of QI interventions for sustainable practice change.
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