title: Selective enrollment in Disease Management Programs for coronary heart disease in Germany - An analysis based on cross-sectional survey and administrative claims data.
abstract: In 2002, Disease Management Programs (DMPs) were introduced within the German healthcare system with the aim to increase the quality of chronic disease care. Due to the enrollment procedures, it can be assumed a) that only certain patients actively decide to enroll in a DMP and/or b) that only certain patients get the recommendation for DMP enrollment from their physician. How strong this assumed effect of self- and/or professional selection is, is still unclear.
  
  
  
  We used data from a cross-sectional postal-survey linked on individual level with administrative claims data from a German sickness fund. The sample consisted of individuals suffering from coronary heart disease (CHD) who i) were either enrolled in the respective DMP or ii) fulfilled the disease related criteria for enrollment but were not enrolled. We applied multivariate logistic regression analyses to assess factors on patient level associated with DMP enrollment.
  
  
  
  We included 7070 individuals in our analyses. Male sex, higher age and receiving old age pension, a higher Charlson Score and a diagnosis of type 2 diabetes increased the odds for DMP-CHD enrollment significantly. Individuals with a diagnosed myocardial infarction (MI) were also more likely to be enrolled in the DMP-CHD. We found a significant interaction effect for MI and sex, indicating that the association between MI and DMP enrollment is stronger for women than for men.
  
  
  
  DMP-enrollees and non-enrollees differ in various factors. Studies analyzing the effectiveness of DMP-CHD should carefully take into account these group differences. Furthermore, the results suggest that the DMP-CHD assessed reaches men better than women.
authors.affiliation: Department of Health Care Management, Technical University Berlin, and Centre for Health Economics Research, Strasse des 17. Juni 135, 10623, Berlin, Germany. Julia.roettger@tu-berlin.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Röttger
authors.affiliation: Department of Health Care Management, Technical University Berlin, and Centre for Health Economics Research, Strasse des 17. Juni 135, 10623, Berlin, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Blümel
authors.affiliation: Department of Health Care Management, Technical University Berlin, and Centre for Health Economics Research, Strasse des 17. Juni 135, 10623, Berlin, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy; D003324:Coronary Artery Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D019468:Disease Management; D005260:Female; D005858:Germany; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D018579:Patient Selection; D011795:Surveys and Questionnaires
keywords: Administrative claims data; Chronic care; Chronically ill; Coronary heart disease; Disease management program; Germany; Selective enrollment; Structured care; Survey data