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.
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.


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.
Rothe
Ulrike
U
Institute for Medical Informatics and Biometrics, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. u_rothe@imib.med.tu-dresden.de
Müller
Gabriele
G
Schwarz
Peter E H
PE
Seifert
Martin
M
Kunath
Hildebrand
H
Koch
Rainer
R
Bergmann
Sybille
S
Julius
Ulrich
U
Bornstein
Stefan R
SR
Hanefeld
Markolf
M
Schulze
Jan
J
D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012106:Research / Q000639:trends*