Abstract
Disease management programmes are increasingly used to improve the efficacy and effectiveness of chronic care delivery. But, disease management programme development and implementation is a complex undertaking that requires effective decision-making. Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability. To increase our understanding of the choices that primary healthcare practices face when implementing such programmes and to stimulate successful implementation and sustainability, we compared the early implementation of eight cardiovascular disease management programmes initiated and managed by healthcare practices in various regions of the Netherlands. Using a mixed-methods design, we identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management level, healthcare utilisation costs, development costs and health-related quality of life. Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable implementation of cardiovascular disease management programmes, although development costs of the individual programmes varied considerably in relation to the length of the development period. The large number of professionals involved in combination with duration of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new care pathways did not directly contribute to higher costs, delays in implementation indirectly did. Developing and implementing cardiovascular disease management programmes is time-consuming and challenging. Multidisciplinary, patient-centred care demands multifaceted changes in routine care. As care pathways become more complex, they also become more expensive. Better preparedness and training can prevent unnecessary delays during the implementation period and are crucial to reducing costs.
Highlights
Chronic diseases are major causes of death and disability worldwide, and the prevalence of such diseases is increasing [1]
We describe the varieties in patient characteristics, quality of chronic care delivery, health care utilisation costs, development costs, and patient outcomes among newly developed cardiovascular disease management programmes in the Netherlands
Health-related quality of life was highest at Stichting Eerstelijns Samenwerking Achterveld and lowest at Onze Lieve Vrouwe Gasthuis, Regionale Organisatie Huisartsen Amsterdam and Radboud
Summary
Chronic diseases are major causes of death and disability worldwide, and the prevalence of such diseases is increasing [1]. Primary care practices that employ the chronic care model support selfmanagement abilities of chronically ill patients through education, lifestyle programs, and skills building (self-management support), redesign the way care is delivered to chronically ill patients (delivery system design), use evidence (e.g. care standards and clinical guidelines) to provide quality of care (decision support), and implement information systems to improve communication and coordination among professionals, provide timely reminders, feedback, and other methods that increased their visibility at the time of clinical decision-making, monitor effectiveness of care for individual patients (clinical information systems) [7,18]. Choices made in the earliest phases of programme development are crucial, as they impact costs, outcomes and sustainability
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