Economic evaluation of a diabetes disease management programme with a central role for the diabetes nurse specialist

Abstract

Background: In the region of Maastricht, The Netherlands, a disease management programme (DMP) for patients with diabetes mellitus was implemented. The programme aims to improve quality of care within existing budgets. To achieve this, diabetes nurse specialists (DNSs) were given a central role within a multidisciplinary team of care providers. This study describes the cost-effectiveness of this approach. Aim: To measure the incremental cost-effectiveness of a diabetes DMP, with a central role for the diabetes nurse specialist, in comparison to usual diabetes care. Methods: Within the DMP, patients with low, medium and high complexities of care are cared for by general practitioners, DNSs and endocrinologists, respectively. The DNSs independently treat patients assigned to them and pay special attention to extensive self-management education. A quasi-experimental trial with two-year follow-up (n=473) was undertaken to measure the cost-effectiveness of the DMP compared with usual care. Results: A total of 23% of patients were assigned to the GP, 66% to the DNS and 10% to the endocrinologist. Statistical significant improvements in glycaemic control, health-related quality of life, compliance and most aspects of self-care behaviour were found. No statistically significant changes were found concerning total costs of care. All improvements were greatest in patients assigned to DNS. Conclusion: A DMP in which DNSs play a central role is associated with improved quality of care within existing budgets. Patients assigned to DNS benefit most, indicating that the central role of DNS in the diabetes DMP is one of its critical success factors.Eur Diabetes Nursing 2007; 4(2): 64-71. Key WordsDiabetes nurse specialist; multidisciplinary team; disease management programme; economic evaluation February 2002, patients were recruited from a convenience sample of nine randomly chosen general practices (involving 12 GPs) and the hospital's outpatient department; they were followed for 24 months. Subsequently, patients with a diagnosis of diabetes mellitus and aged ≥16 years were invited to participate. Since the DMP aimed to cover the entire population of people with diabetes (including patients with complications and/or co-morbidity), only patients with severe co-morbidity, such as pre-terminal renal failure or carcinoma and/or those needing dialysis, were excluded. Authors Study designA single-group pre-post test design was applied, 18 since the DMP was implemented region-wide and a 'fair' comparison region was unavailable. In all potential comparison regions, innovations that would bias the measure of usual care, such as self-management programmes or electronic patient record devices, were being implemented. Disease management programmeThe DMP involves all patients with type 1 or 2 diabetes mellitus who are known by the GP. The main features of the DMP are: use of evidencebased guidelines; central co-ordination of care; assignment of patients to a care provider; and central data collection with annual individual feedbac...

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