What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs

<p><strong>Background</strong>: Disease management programs (DMP) aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs.</p><p><strong>Research design and methods:</strong> Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (N=316) and data from electronic medical records (EMR) (N=9023), and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard.</p><p><strong>Results:</strong> On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. 96% contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs.</p><p><strong>Conclusion:</strong> Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care.</p

Clinical decision support systems for primary care: the identification of promising application areas and an initial design of a CDSS for lower back pain

Decision support technology has the potential to change the way professionals treat patients for the better. We questioned thirty-three healthcare professionals on their view about the usage of eHealth technology within their daily practice, and areas in which decision support can play a role, to lower healthcare professionals’ workload. Qualitative analysis resulted in an overview of desired eHealth functionalities and promising areas for decision support technology within primary care. Based on these results, we discuss future work in which we will focus on the development, and evaluation of a clinical decision support system (CDSS) for advising patients with physical complaints on whether they should see a healthcare professional or can perform self-care. Next, the CDSS should advise healthcare professionals in selecting relevant training exercises for a specific patient. In first instance, this CDSS is focused on diagnostic triaging and selection of training exercises for patients with nonspecific lower back pain

Results after one year introduction of disease oriented payments in the Netherlands

PURPOSE: The purpose of our study was to show the first results after introduction of disease oriented payments for diabetes mellitus type II in the Netherlands. THEORY: In 2010 disease oriented payment for diabetes mellitus type II was introduced nationwide in the Netherlands. In disease oriented payment, care for disease groups is organised by a care group that organises both general and more specialised care, and that negotiate a lumpsum for each patient with the health insurer. The care groups can either provide care themselves or sub-contract other providers. Included services within the care program are based on national health care standards. Aim of disease oriented payments is to improve care for chronically ill, by stimulating multidisciplinary collaboration between health care providers. METHODS: Selection of patients, health care utilization, organisation of care and self management needs were analysed with the aid data from written structured questionnaires from the National Panel of people with Chronic Illness or Disability (n=275) and data from electronic medical records of general practitioners (n=1144). Diabetes patients with and without disease oriented payment were compared. RESULTS AND CONCLUSIONS: Our first results show no evidence of selection of patients within disease oriented payments. And hardly any differences in the care between diabetes patients with and without disease oriented payments. Diabetes patients within disease oriented payments tended to go less often to a dietician after the introduction of disease oriented payments. It seems that patients within disease oriented payments receive part of their care from less specialist health care providers. Also, care to diabetes patients within disease oriented payment was only to a limited degree provided according to a programmatic approach