Abstract
BackgroundMore than half of the patients with type 2 diabetes (T2DM) patients are diagnosed with one or more comorbid disorders. They can participate in several single-disease oriented disease management programs, which may lead to fragmented care because these programs are not well prepared for coordinating care between programs. Comorbid patients are therefore at risk for suboptimal treatment, unsafe care, inefficient use of health care services and unnecessary costs. Case management is a possible model to counteract fragmented care for comorbid patients. It includes evidence-based optimal care, but is tailored to the individual patients' preferences.The objective of this study is to examine the effectiveness of a case management program, in addition to a diabetes management program, on the quality of care for comorbid T2DM patients.Methods/DesignThe study is a randomized controlled trial among patients with T2DM and at least one comorbid chronic disease (N = 230), who already participate in a diabetes management program. Randomization will take place at the level of the patients in general practices. Trained practice nurses (case managers) will apply a case management program in addition to the diabetes management program. The case management intervention is based on the Guided Care model and includes six elements; assessing health care needs, planning care, create access to other care providers and community resources, monitoring, coordinating care and recording of all relevant information. Patients in the control group will continue their participation in the diabetes management program and receive care-as-usual from their general practitioner and other care providers.DiscussionWe expect that the case management program, which includes better structured care based on scientific evidence and adjusted to the patients' needs and priorities, will improve the quality of care coordination from both the patients' and caregivers' perspective and will result in less consumption of health care services.Trial registrationNetherlands Trial Register (NTR): NTR1847
Highlights
More than half of the patients with type 2 diabetes (T2DM) patients are diagnosed with one or more comorbid disorders
We expect that the case management program, which includes better structured care based on scientific evidence and adjusted to the patients’ needs and priorities, will improve the quality of care coordination from both the patients’ and caregivers’ perspective and will result in less consumption of health care services
The objective of this study is to establish the additional value of case management superposed on a diabetes management program, in terms of perceived quality of care, quality of care from the perspective of the General Practitioner (GP), the health status of the patient, diabetes control, and health care utilization in type 2 Diabetes Mellitus (T2DM) patients with comorbidity
Summary
In this paper we describe the design of a randomized controlled trial of a case management program led by a trained PN, the case manager, for comorbid T2DM patients. This could influence the external validity of the study At this moment the majority of the T2DM patients in the Netherlands are included in a disease management program, which means that structured diabetes management is more or less ‘usual care’ in primary care. The case managers work together with the PN and GP to discuss the results from the initial assessment and during the design of the care plan before it is presented to the patient During this contact the GP and PN might get motivated to use specific elements in the usual care group, who do not receive the intervention. The GP and PN are not involved in the program (the actual problem assessment with the patients, the monthly monitoring, the contacts between the case manager and participant) and we expect this form of contamination, if it occurs, will be washed out in a short period and will not influence the intervention effect after 12 months.
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