Journal of Public Health

, Volume 20, Issue 1, pp 41–46 | Cite as

Comorbidity and patient-reported quality of care: an evaluation of the primary care based German disease management program for type 2 diabetes

  • Dominik OseEmail author
  • Tobias Freund
  • Elisabeth Urban
  • Cornelia Ursula Kunz
  • Joachim Szecsenyi
  • Antje Miksch
Original Article



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.


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.


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.


Chronic care model Quality of care Patients view Comorbidity Disease management Diabetes 



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.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Dominik Ose
    • 1
    Email author
  • Tobias Freund
    • 1
  • Elisabeth Urban
    • 1
  • Cornelia Ursula Kunz
    • 2
  • Joachim Szecsenyi
    • 1
  • Antje Miksch
    • 1
  1. 1.Department of General Practice and Health Services ResearchUniversity Hospital of HeidelbergHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity Hospital of HeidelbergHeidelbergGermany

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