Abstract
BackgroundDisease management programmes (DMPs) have been developed to improve effectiveness and economic efficiency within chronic care delivery by combining patient-related, professional-directed, and organisational interventions. The benefits of DMPs within different settings, patient groups, and versions remain unclear. In this article we propose a protocol to evaluate a range of current DMPs by capturing them in a single conceptual framework, employing comparable structure, process, and outcome measures, and combining qualitative and quantitative research methods.MethodsTo assess DMP effectiveness a practical clinical trial will be conducted. Twenty-two disease management experiments will be studied in various Dutch regions consisting of a variety of collaborations between organisations and/or professionals. Patient cohorts include those with cardiovascular diseases, chronic obstructive pulmonary disease, diabetes, stroke, depression, psychotic diseases, and eating disorders. Our methodological approach combines qualitative and quantitative research methods to enable a comprehensive evaluation of complex programmes. Process indicators will be collected from health care providers' data registries and measured via physician and staff questionnaires. Patient questionnaires include health care experiences, health care utilisation, and quality of life. Qualitative data will be gathered by means of interviews and document analysis for an in depth description of project interventions and the contexts in which DMPs are embedded, and an ethnographic process evaluation in five DMPs. Such a design will provide insight into ongoing DMPs and demonstrate which elements of the intervention are potentially (cost)-effective for which patient populations. It will also enable sound comparison of the results of the different programmes.DiscussionThe study will lead to a better understanding of (1) the mechanisms of disease management, (2) the feasibility, and cost-effectiveness of a disease management approach to improving health care, and (3) the factors that determine success and failure of DMPs. Our study results will be relevant to decision makers and managers who confront the challenge of implementing and integrating DMPs into the health care system. Moreover, it will contribute to the search for methods to evaluate complex healthcare interventions.
Highlights
Disease management programmes (DMPs) have been developed to improve effectiveness and economic efficiency within chronic care delivery by combining patient-related, professional-directed, and organisational interventions
The effectiveness of multifaceted DMPs is the focus of our study
Glasgow et al [14] have called for the evaluation of DMPs through practical clinical trials conducted in multiple representative settings, the inclusion of diverse patient groups, the comparison of alternative versions of programmes, and employing multiple measures of relevance to patients, clinicians, and policymakers
Summary
Disease management programmes (DMPs) have been developed to improve effectiveness and economic efficiency within chronic care delivery by combining patient-related, professional-directed, and organisational interventions. In this article we propose a protocol to evaluate a range of current DMPs by capturing them in a single conceptual framework, employing comparable structure, process, and outcome measures, and combining qualitative and quantitative research methods Chronic diseases such as cardiovascular diseases (CVD), diabetes, cancer and respiratory diseases are major causes of death and disability worldwide and their prevalence is expected to rise [1]. Glasgow et al [14] have called for the evaluation of DMPs through practical clinical trials conducted in multiple representative settings, the inclusion of diverse patient groups, the comparison of alternative versions of programmes, and employing multiple measures of relevance to patients, clinicians, and policymakers Such practical trials should be accompanied by thorough and in depth qualitative analysis of organisational and professional processes in order to explain outcomes
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