Abstract
Aims
Previous evaluations of the German disease management program (DMP) for type 2 diabetes show that this approach curbs drug and hospital costs, may reduce mortality and improve quality of diabetes care. Otherwise until now there have been no evaluations which analyse the impact of comorbidity (COMORB) on the effectiveness of German DMP to strengthen patient-reported quality of care. Therefore, the study aimed to assess and compare the impact of comorbidity on patient-reported quality of care for patients participating in DMP and in routine care (RC).
Subject and methods
A questionnaire including the Patient Assessment of Chronic Illness Care (PACIC) was mailed to a random sample of 3,546 patients. We grouped patients according to their participation into DMP and RC. To compare groups, we performed analysis of covariance. We considered all main effects, the interaction of DMP * COMORB and assessed the estimated PACIC scores for each number of other conditions.
Results
1,532 questionnaires were returned (42.2%). Valid data existed for 1,399 patients. The analysis showed that only participation in the DMP (p < 0.0001) and gender (p < 0.001) had an impact on the PACIC. The estimated PACIC score of patients in DMP was higher than in routine care for all numbers of other conditions. Whereas the increasing number of other conditions was associated with lower PACIC scores in DMP, it was associated with increased PACIC scores in RC.
Conclusion
Patients with type 2 diabetes in DMP had higher PACIC scores than patients in RC, irrespective of the number of other conditions. Our study revealed no significant impact of comorbidity on the effect of German DMP on patient-reported quality of care.
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References
Altenhofen L, Blaschy S, Hagen B, Haß W, Kretschmann J (2008) Qualitätsbericht 2008 [Disease Management Programme in Nordrhein]. Nordrheinische Gemeinsame Einrichtung, Düsseldorf, Germany
Esteghamati A, Khalilzadeh O, Anvari M, Meysamie A, Abbasi M, Forouzanfar M, Alaeddini F (2009) The economic costs of diabetes: a population based study in Teheran, Iran. Diabetologia 52:1520–1527
Freund T, Wensing M, Mahler C, Gensichen J, Erler A, Beyer M, Gerlach FM, Szecsenyi J, Peters-Klimm F (2010) Development of a primary care-based complex care management intervention for chronically ill patients at high risk for hospitalization: a study protocol. Implement Sci. doi:10.1186/1748-5908-5-70
Gandhi GY, Murrad MH, Fujiyosi A, Mullan RJ, Flynn DN, Elamin MB, Swiglo BA, Isley WL, Guyatt GH, Montori VM (2008) Patient-important outcomes in registered diabetes trials. JAMA 299:2543–2549
Glasgow RE, Hiss RG, Anderson RM, Friedman NM, Hayward RA, Marrero DG, Taylor CB, Vinicor F (2001) Report of the health care delivery work group: behavioral research related to the establishment of a chronic disease model for diabetes care. Diabetes Care 24:124–130
Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM (2005) Development and validation of the patient assessment of chronic illness care (PACIC). Med Care 43:436–444
Glasgow RE, Peeples M, Skovlund SE (2008) Where is the patient in diabetes performance measures? The case for including patient-centered and self management measures. Diabetes Care 31:1046–1050
Halanych JH, Safford MM, Keys WC, Person SD, Shikany JM, Kim YI, Centor RM, Allison JJ (2007) Burden of comorbid medical conditions and quality of diabetes care. Diabetes Care 30:2999–3004
Higashi T, Wenger NS, Adams JL, Fung C, Roland M, McGlynn EA, Reeves D, Asch SM, Kerr EA, Shekelle PG (2007) Relationship between number of medical conditions and quality of care. N Engl J Med 356:2496–2504
Joos S, Rosemann T, Heiderhoff M, Wensing M, Ludt S, Gensichen J, Kaufmann-Kolle P, Szecsenyi J (2005) ELSID-Diabetes study-evaluation of a large scale implementation of disease management programmes for patients with type 2 diabetes: rationale, design and conduct—a study protocol [ISRCTN08471887]. BMC Pub Health 5:99
Kerr EA, Heisler M, Krein SL, Kabeto M, Langa KM, Weir D, Piette JD (2007) Beyond comorbidity counts: How do comorbidity type and severity influence diabetes patients’ treatment priorities and self-management? J Gen Intern Med 22:1635–1640
Miksch A, Hermann K, Roelz A, Joos S, Szecsenyi J, Ose D, Rosemann T (2009) Additional impact of concomitant hypertension and osteoarthritis on quality of life among patients with type 2 diabetes in primary care in Germany—a cross sectional survey. Health Qual Life Outcomes 7:19
Miksch A, Laux G, Ose D, Joos S, Campbell S, Riens B, Szecsenyi J (2010) Is there a survival benefit for patients with type 2 diabetes enrolled in the German primary care-based Disease Management Program? Am J Manage Care 16:49–54
Ose D, Wensing M, Szecsenyi J, Joos S, Hermann K, Miksch A (2009) Impact of primary care-based disease management on the health-related quality of life in patients with type 2 diabetes and comorbidity. Diabetes Care 32:1594–1596
Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, Landgraf R (2006) Patient and provider perceptions of care for diabetes: results of the cross-national DWAN study. Diabetologia 49:279–288
Renders CM, Valk GD, Griffin S, Wagner EH, van Eijk JThM, Assendelft WJJ (2001) Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database Syst Rev 1:CD001481
Rothe U, Müller G, Schwarz PE, Seifert M, Kunath H, Koch R, Bergmann S, Julius U, Bornstein SR, Hanefeld M, Schulze J (2008) Evaluation of a diabetes management system based on practice guidelines, integrated care, and continuous quality management in a Federal State of Germany: a population-based approach to health care research. Diabetes Care 31:863–868
Rosemann T, Laux G, Droesemeyer S, Gensichen J, Szecsenyi J (2007) Evaluation of a culturally adapted German version of the Patient Assessment of Chronic Illness Care (PACIC-5a) questionnaire in a sample of osteoarthritis patients. J Eval Clin Pract 13:806–813
Schmittdiel J, Mosen DM, Glasgow RE, Hibbard J, Remmers C, Bellows J (2007) Patient Assessment of Chronic Illness Care (PACIC) and improved patient-centered outcomes for chronic conditions. J Gen Intern Med 23:77–80
Stock S, Drabik A, Büscher G, Graf C, Ullrich W, Gerber A, Lauterbach KW, Lüngen M (2010) German diabetes management programs improve quality of care and curb costs. Health Aff 29:2197–2205
Szecsenyi J, Rosemann T, Joos S, Peters-Klimm F, Miksch A (2008) German diabetes disease management programs are appropriate for restructuring care according to the chronic care model: an evaluation with the patient assessment of chronic illness care instrument. Diabetes Care 31:1150–1154
Wexler DJ, Grant RW, Wittenberg E, Bosch JL, Cagliero E, Delahanty L, Blais MA, Meigs JB (2006) Correlates of health related quality of life in type 2 diabetes. Diabetologia 49:1489–1497
Acknowledgements
We are grateful to the regional health funds of AOK Sachsen-Anhalt and AOK Rheinland Pfalz for support in sending out the study documents to their policyholders and for the preparation of claims data for sampling purposes. We would like to thank B. Riens (AQUA-Institute), J. Trieschmann and A. Roelz for support in organisation. This study is an investigator-initiated trial funded by the Federal Association of Statutory Regional Health Funds (AOK Bundesverband). Under the contract between the sponsor and the University of Heidelberg, full responsibility for the scientific work, the management of data and analysis and publication remains with the investigators.
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The authors declare that they have no conflict of interest.
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Ose, D., Freund, T., Urban, E. et al. Comorbidity and patient-reported quality of care: an evaluation of the primary care based German disease management program for type 2 diabetes. J Public Health 20, 41–46 (2012). https://doi.org/10.1007/s10389-011-0429-z
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DOI: https://doi.org/10.1007/s10389-011-0429-z