Evaluation of a Diabetes Management System Based on Practice Guidelines, Integrated Care, and Continuous Quality Management in a Federal State of Germany

Abstract

OBJECTIVE—The aim of this study was to evaluate the Saxon Diabetes Management Program (SDMP), which is based on integrated practice guidelines, shared care, and integrated quality management. The SDMP was implemented into diabetes contracts between health insurance providers, general practitioners (GPs), and diabetes specialized practitioners (DSPs) unified in the Saxon association of Statutory Health Insurance Physicians. RESEARCH DESIGN AND METHODS—The evaluation of the SDMP in Germany represents a real-world study by using clinical data collected from participating physicians. Between 2000 and 2002 all DSPs and about 75% of the GPs in Saxony participated. Finally, 291,771 patients were included in the SDMP. Cross-sectional data were evaluated at the beginning of 2000 (group A1) and at the end of 2002 (group A2). A subcohort of 105,204 patients was followed over a period of 3 years (group B). RESULTS—The statewide implementation of the SDMP resulted in a change in therapeutic practice and in better cooperation. The median A1C at the time of referral to DSPs decreased from 8.5 to 7.5%, and so did the overall mean. At the end, 78 and 61% of group B achieved the targets for A1C and blood pressure, respectively, recommended by the guidelines compared with 69 and 50% at baseline. Patients with poorly controlled diabetes benefited the most. Preexisting regional differences were aligned. CONCLUSIONS—Integrated care disease management with practicable integrated quality management including collaboration between GPs and specialist services is a significant innovation in chronic care management and an efficient way to improve diabetes care continuously.

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

“…Previous evaluations of the German DMP for type 2 diabetes show that this program curbs drug and hospital costs, may reduce mortality (Stock et al 2010;Miksch et al 2010), and improves the ongoing quality of diabetes care (Rothe et al 2008;Szecsenyi et al 2008). However, dealing with comorbidity is an enormous challenge in the German DMP for type 2 diabetes.…”

Swiss Quality and Outcomes Framework: Quality Indicators for Diabetes Management in Swiss Primary Care Based on Electronic Medical Records

“…Moreover, experience from the NHS QOF and similar incentive-based disease management programs in other countries underline the influence of financial incentives on the quality of medical documentation. For instance, in Germany, the Saxon Diabetes Management Program that compromised, inter alia, incentives for data documentation by GPs, reported an increase of completed data to 91-98% [37]. On the other hand, retrospective investigations in England have shown that an overall increase of the recorded quality of diabetes care had already existed in the pre-QOF period, just like in other countries and irrespective of the introduction of the pay-for-performance scheme in 2004 [28,38,39].…”

Diabetes prevention: global health policy and perspectives from the ground

“…Scientific outcome evaluation indicators and measurement recommendations (e.g., body weight, waist circumference, HbA 1c and total energy intake) have been developed to monitor the effectiveness and efficiency of the programs [56]. Recent experience demonstrates that monitoring alone, as a function of quality management, is a driver for increasing the quality of intervention programs [57]. The CDC DPRP, as part of the National DPP, serves this monitoring function for diabetes prevention programs in the USA.…”