The development of integrated diabetes care in the Netherlands: a multiplayer self-assessment analysis

Nick Zonneveld,Lidewij E Vat,Hans Vlek,Mirella M N Minkman

doi:10.1186/s12913-017-2167-6

Abstract

BackgroundSince recent years Dutch diabetes care has increasingly focused on improving the quality of care by introducing the concept of care groups (in Dutch: ‘zorggroepen’), care pathways and improving cooperation with involved care professionals and patients. This study examined how participating actors in care groups assess the development of their diabetes services and the differences and similarities between different stakeholder groups.MethodsA self-evaluation study was performed within 36 diabetes care groups in the Netherlands. A web-based self-assessment instrument, based on the Development Model for Integrated Care (DMIC), was used to collect data among stakeholders of each care group. The DMIC defines nine clusters of integrated care and four phases of development. Statistical analysis was used to analyze the data.ResultsRespondents indicated that the diabetes care groups work together in well-organized multidisciplinary teams and there is clarity about one another’s expertise, roles and tasks. The care groups can still develop on elements related to the management and monitoring of performance, quality of care and patient-centeredness. The results show differences (p < 0.01) between three stakeholders groups in how they assess their integrated care services; (1) core players, (2) managers/directors/coordinators and (3) players at a distance. Managers, directors and coordinators assessed more implemented integrated care activities than the other two stakeholder groups. This stakeholder group also placed their care groups in a further phase of development. Players at a distance assessed significantly less present elements and assessed their care group as less developed.ConclusionsThe results show a significant difference between stakeholder groups in the assessment of diabetes care practices. This reflects that the professional disciplines and the roles of stakeholders influence the way they asses the development of their integrated care setting, or that certain stakeholder groups could be less involved or informed.

Highlights

Since recent years Dutch diabetes care has increasingly focused on improving the quality of care by introducing the concept of care groups, care pathways and improving cooperation with involved care professionals and patients
The results show that different stakeholder groups experience the development of integrated care differently and that patients are barely involved in the development and monitoring of the diabetes care groups
A first conclusion of this study is that the professionals in the diabetes care groups work together in multi-disciplinary teams with clear roles and tasks

Summary

Introduction

Since recent years Dutch diabetes care has increasingly focused on improving the quality of care by introducing the concept of care groups (in Dutch: ‘zorggroepen’), care pathways and improving cooperation with involved care professionals and patients. Since decades the number of people suffering from diabetes worldwide is growing [1]. According to the Netherlands National Institute for Public Health and the Environment (RIVM), more than 600,000 people were suffering from diabetes in the Netherlands in 2003 [2]. In 2011 approximately 830,000 people suffered from diabetes [3]. In the Netherlands, like in other western countries, diabetes disease management programmes have been introduced in primary care settings as a response to the growing health care costs and demand for quality improvement in diabetes care [6]. In 2013, more than 80% percent of diabetes care in the Netherlands was delivered in primary care settings [8], including former secondary care such as delivering insulin therapy [9]. General practitioners delegated most of diabetes care activities to practice nurses or specially trained diabetes nurses [10]

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