title: Quality of diabetes care in Dutch care groups: no differences between diabetes patients with and without co-morbidity.
abstract: OBJECTIVE
  To evaluate the relationship between presence and nature of co-morbidity and quality of care for diabetes patients enrolled in diabetes disease management programmes provided by care groups.
  
  
  METHODS
  We performed an observational study within eight Dutch diabetes care groups. Data from patient record systems of care groups and patient questionnaires were used to determine quality of care. Quality of care was measured as provision of the recommended diabetes care, patients' achievement of recommended clinical outcomes and patients' perception of coordination and integration of care.
  
  
  RESULTS
  527 diabetes patients without and 1187 diabetes patients with co-morbidity were included. Of the co-morbid patients, 7.8% had concordant co-morbid conditions only, 63.8% had discordant co-morbid diseases only and 28.4% had both types of conditions. Hardly any differences were observed between patients with and without co-morbidity in terms of provided care, achievement of clinical outcomes and perceived coordination and integration of care.
  
  
  CONCLUSIONS
  Our study implies that care groups are able to provide similar quality of diabetes care for diabetes patients with and without co-morbidity. Considering the expected developments regarding additional disease management programmes in care groups, it is of importance to monitor quality of care, including patient experiences, for all chronic diseases. It will then become clear whether accountable provider-led organisations such as care groups are able to ensure quality of care for the increasing number of patients with multiple chronic conditions.
authors.affiliation: National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, The Netherlands.
authors.forename: Simone R
authors.initials: SR
authors.lastname: de Bruin
authors.affiliation: National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, The Netherlands.
authors.forename: Sandra H
authors.initials: SH
authors.lastname: van Oostrom
authors.affiliation: National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, The Netherlands.
authors.forename: Hanneke W
authors.initials: HW
authors.lastname: Drewes
authors.affiliation: National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, The Netherlands.
authors.forename: Janneke T
authors.initials: JT
authors.lastname: de Jong-van Til
authors.affiliation: National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, The Netherlands.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
authors.affiliation: National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, The Netherlands.
authors.forename: Jeroen N
authors.initials: JN
authors.lastname: Struijs
keywords: bundled payment; care groups; co-morbidity; diabetes; disease management; integrated care; quality of care