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

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.

Self-assessed quality of care among adults with diagnosed diabetes in Germany

“…The results of this population-based study show that people with a diagnosed diabetes in the past twelve months assess the quality of the care they receive as moderate. Previous studies examining this indicator carried out in Germany have been based on clinical and regional study populations [ 15–18 ]; they found a similar or slightly better rating of quality of care than in the present study. Differences in the study design and the version of the PACIC questionnaire used mean that these results are only comparable to a limited extent.…”

Diabetes care: Comparison of patients' and healthcare professionals' assessment using the PACIC instrument

“…Diabetes, a frequent chronic disease with an increasing prevalence, is often the target of integrated care initiatives . The PACIC and PACIC‐5A have often been used as instruments for the evaluation of these initiatives . Within such studies, the PACIC and PACIC‐5A are more frequently used than the ACIC; indeed, the latter is directed at HCPs at the organizational level and does not allow a direct comparison between patients and individual HCPs.…”