An evidence-based disease-management program for patients with diabetic nephropathy.
BACKGROUND
In Germany, a surge in the number of dialysis patients is expected over the next 10 years. This article aims to: (1) address this trend by developing an evidence-based disease-management program for patients with diabetic nephropathy and; (2) to identify areas for future research on disease management tools.


METHODS
We conducted a systematic search of studies published between January 1966 and December 2001 investigating the relationship between disease management tools and clinical and economic outcomes of patients with diabetic nephropathy. Studies were categorized according to level of scientific evidence. As a disease management tool when scientific evidence was lacking, expert judgement was used.


RESULTS
We identified 10 studies that formed the scientific basis of this program's recommendations. For patients with incipient or clinical nephropathy the program recommends the implementation of clinical guidelines, patient feedback to physicians and treatment documentation. For predialysis patients it suggests that specialists or a team of specialists coordinate patient care. Further, the program recommends educational sessions, use of case managers and regular quality circles for dialysis patients. Trial evidence suggests that the prospect of cost-saving is greatest for the management of pre-dialysis patients.


CONCLUSIONS
High-quality studies on the use of many disease management tools are lacking, for example, on the role of case managers and primary care physicians in non-dialysis patients. To keep costs manageable the disease-management program can begin with enrolling predialysis patients.
Gandjour
Afschin
A
Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany. afschin.gandjour@medizin.uni-koeln.de
Lauterbach
Karl Wilhelm
KW
D000553:Ambulatory Care / Q000592:standards; D003131:Combined Modality Therapy; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation