[Disease management programs in Germany: Validity of the medical documentation].
OBJECTIVE
The specific documentation for disease management programs (DMP) in Germany with respect to § 137 Social Code Book V is the basis for evaluating the DMP. DMP run up costs of the order of a billion euro without assessing evidence-based benefit so far. Aim of this study was to question if and to which extent this documentation may be suitable for reliable quality assurance in its present form.


METHODS
Data of nearly 300000 insured persons of a German Statutory Health Insurance (Techniker Krankenkasse, TK) which were continuously registered from July 1st 2009 until December 31st 2010 in a DMP were analyzed. We analyzed how items which were components of claims data and of DMP documentation were matched.


RESULTS
With regard to prescriptions there were some considerable differences. Prescription of glibenclamid was documented twice as frequently in the DMP documentation compared to prescriptions filled in pharmacies. Only a fraction of emergency hospitalizations documented in the claims data were found in the DMP documentation. Investigations of the fundus oculi for diabetics are mentioned three times more frequently in the DMP documentation than they are accounted by ophthalmologists.


CONCLUSIONS
There are considerable differences between claims data and DMP specific documentation. The latter shows a plainly reduced validity for investigated fields in the documentation forms. Reasons for this are manifold. Former evaluations of DM Ps carried out just on the basis of DMP documentation are thus highly questionable. Therefore, the DMPs themselves and their documentation have to be reformed.
WINEG - Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen, Hamburg.
R
R
Linder
WINEG - Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen, Hamburg.
D
D
Horenkamp-Sonntag
WINEG - Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen, Hamburg.
S
S
Engel
Fachreferat Disease-Management-Programme der Techniker Krankenkasse, Hamburg.
D
D
Köppel
Fachreferat Disease-Management-Programme der Techniker Krankenkasse, Hamburg.
T
T
Heilmann
WINEG - Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen, Hamburg.
F
F
Verheyen
D002908:Chronic Disease / Q000453:epidemiology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D019468:Disease Management; D004282:Documentation / Q000592:standards* / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D008019:Life Style; D009313:National Health Programs / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000592:standards / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards* / Q000706:statistics & numerical data*; D016896:Treatment Outcome