title: From shared care to disease management: key-influencing factors.
abstract: BACKGROUND
  In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called 'shared care' projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care.
  
  
  OBJECTIVE
  Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked?
  
  
  BACKGROUND
  The theoretical framework is based on the concept of the learning organisation.
  
  
  METHODS
  Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project.
  
  
  RESULTS
  In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skillful way.
  
  
  CONCLUSIONS
  Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed.
authors.affiliation: Faculty of Health Sciences, Department of Health Organisation, Policy and Economics, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands. I.Eijkelberg@beoz.unimaas.nl
authors.forename: I M
authors.initials: IM
authors.lastname: Eijkelberg
authors.forename: C
authors.initials: C
authors.lastname: Spreeuwenberg
authors.forename: I M
authors.initials: IM
authors.lastname: Mur-Veeman
authors.forename: B H
authors.initials: BH
authors.lastname: Wolffenbuttel