[Evaluation of disease management programmes--assessing methods and initial outcomes from a health economic perspective].
Evaluation represents a substantial component of the concept of Disease Management Programmes. This and the fact that the implementation of Disease Management Programmes constitutes a major change in the German healthcare system require that the criteria established by the German Federal Social Insurance Authority (Bundesversicherungsamt) be carefully reviewed. The present paper focuses on the evaluation method and the economic data. The pre-/-post study design used in the evaluation is known to be vulnerable to threats to internal validity. The objective of this paper is to analyze whether these threats to internal validity which have been known theoretically are confirmed by the results of the final reports. A review of the final reports of health insurance companies like the AOK, Barmer and a group of the BKK in Westfalen-Lippe shows that this question can be answered in the affirmative. The pre-/-post design without control groups is unable to recognize the failure or success of the Disease Management concept. The reasons include a high drop-out rate as well as the lack of consideration of the characteristics of chronic disease. Hence the evaluation method has failed to prove the quality of Disease Management Programmes in Germany. This is why consistent further development is needed.
Birnbaum
Dana Sophie
DS
Forschungsstelle für Gesundheitsökonomie, Leibniz Universität Hannover, Hannover, Deutschland.
Braun
Sebastian
S
D002908:Chronic Disease / Q000191:economics / Q000628:therapy; D015331:Cohort Studies; D019468:Disease Management; D005858:Germany; D017048:Health Care Costs; D018166:Health Care Reform; D006801:Humans; D008297:Male; D010352:Patient Dropouts; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards; D018570:Risk Assessment; D016896:Treatment Outcome