The role of disease management programs in the health behavior of chronically ill patients.
OBJECTIVE
Investigate the effects of disease management program (DMP) implementation on physical activity, smoking, and physical quality of life among chronically ill patients.


METHODS
This study used a mixed-methods approach involving qualitative (35 interviews with project managers) and quantitative (survey of patients from 18 DMPs) data collection. Questionnaire response rates were 51% (2010; 2619/5108) at T0 and 47% (2011; 2191/4693) at T1.


RESULTS
Physical activity and the percentage of smokers improved significantly over time, whereas physical quality of life declined. After adjusting for patients' physical quality of life at T0, age, educational level, marital status, and gender, physical activity at T0 (p<0.01), changes in physical activity (p<0.001), and percentage of smokers at T0 (p<0.05) predicted physical quality of life at T1. Project managers reported that DMPs improved patient-professional interaction. The ability to set more concrete targets improved patients' health behaviors.


CONCLUSIONS
DMPs appear to improve physical activity among chronically ill patients over time. Furthermore, (changes in) health behavior are important for the physical quality of life of chronically ill patients.


CONCLUSIONS
Redesigning care systems and implementing DMPs based on the chronic care model may improve health behavior among chronically ill patients.
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Jane Murray
JM
Cramm
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Samantha A
SA
Adams
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Bethany Hipple
BH
Walters
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Apostolos
A
Tsiachristas
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Roland
R
Bal
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Robbert
R
Huijsman
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Maureen P M H
MP
Rutten-Van Mölken
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands. Electronic address: cramm@bmg.eur.nl.
Anna Petra
AP
Nieboer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D019468:Disease Management; D005260:Female; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009313:National Health Programs / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D036301:Qualitative Research; D011788:Quality of Life; D012907:Smoking; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
Chronic care; Disease management; Health behavior; Integrated care; Quality of life