gms | German Medical Science

Background and state of research: Disease Management Programs (DMPs) are structured treatment programs aiming to improve health outcomes and save costs for patients suffering from chronic conditions. In Switzerland, DMPs are not officially regulated, nor have they been systematically introduced in the health care setting. A healthcare provider network initiated the DMP under evaluation which was implemented over a 4-year period at different practice sites. The DMP consists of a guideline-adherent individualized treatment plan for diabetes type 1 and 2 patients, a continuous evaluation of processes, interprofessional collaboration and workshops, as well as quality circles.

Research question and objectives, hypothesis: To provide evidence of the efficacy and effectiveness of the DMP under review. Timely feedback enables involved healthcare providers to address areas for improvement.

Method: We employed two approaches to evaluate the DMP during up to four years of follow-up:

1.

A difference-in-difference (DiD) design using claims data of patients of practice sites with a DMP implemented and a control group (N = 22’222 patients) was used to analyze the DMPs’ impact on treatment guideline adherence, hospitalization risk, and health care costs at the patient level.

2.

Descriptive analysis of eight routinely collected process and clinical measures defined by the Swiss Society of Endocrinology and Diabetology (SGED) to assess the quality of care of the healthcare centers with a DMP implemented (N = 1,078 to 1,652 patients, depending on analysis year).

Results:

1.

We identified a positive impact of the DMP on guideline adherence (DiD estimates for improvement in year 1: +4%-points; year 2: +7%-points; year 3: +6%-points; and year 4: +6%-points). No impact on hospitalization risk was found. The increase in healthcare costs was smaller in the intervention group compared to the control group (DiD estimates in year 1: CHF -483 CHF; year 2: CHF -144; year 3: CHF -347; and year 4: CHF -1,129).

2.

Most process and clinical measures improved slightly, while the rest remained unchanged during the follow-up period.

Discussion: Implementation of the DMP had a positive impact on the quality and costs of diabetes care, as reflected in improvements in guideline-adherent care, lower healthcare costs, and slightly improved process and clinical measures. On a meta-level, our contribution shows how scientific evidence can inform improvements in primary care by collaborating closely with healthcare providers. We present some challenges we faced and provide lessons learned, particularly: effective communication of findings, issues with data quality, lack of time and resources among healthcare personnel, and insufficient digitalization.