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

A population-based approach to health care research

  1. Ulrike Rothe, MD1,
  2. Gabriele Müller, MPH1,
  3. Peter E.H. Schwarz, MD2,
  4. Martin Seifert, MSC1,
  5. Hildebrand Kunath, PHD, MD1,
  6. Rainer Koch, PHD1,
  7. Sybille Bergmann, PHD3,
  8. Ulrich Julius, PHD, MD2,
  9. Stefan R. Bornstein, PHD, MD2,
  10. Markolf Hanefeld, PHD, MD4 and
  11. Jan Schulze, PHD, MD25
  1. 1Institute for Medical Informatics and Biometrics, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
  2. 2Department of Medicine III, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
  3. 3Institute for Clinical Chemistry and Laboratory Medicine, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
  4. 4Centre for Clinical Studies, Society for Science and Technology Transfer, Technical University of Dresden, Dresden, Germany
  5. 5Saxon Chamber of Physicians, Dresden, Saxony, Germany
  1. Corresponding author: Dr. Ulrike Rothe, Institute for Medical Informatics and Biometrics, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. E-mail: u_rothe{at}imib.med.tu-dresden.de

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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 10 March 2008. DOI: 10.2337/dc07-0858.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted January 25, 2008.
    • Received May 3, 2007.
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  1. Published online before print March 10, 2008, doi: 10.2337/dc07-0858 Diabetes Care May 2008 vol. 31 no. 5 863-868
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