Participation of general practitioners in disease management: experiences from the Netherlands

OBJECTIVE: To investigate the extent to which GPs in the Netherlands participate in disease management and how personal opinions, impeding and promoting incentives as well as physician characteristics influence their attitude towards disease management. METHODS: The attitude-model of Fishbein and Ajzen was used to describe the attitude of GPs towards disease management and main influencing factors. After interviewing seventeen representatives of the GPs and testing a questionnaire, the final questionnaire was sent to all GPs in the Netherlands (7680 GPs) barring those involved in the testing of the questionnaire. RESULTS: At least 10.4% of all Dutch GPs are active in disease management. The main factors predicting a positive attitude towards disease management are the following: GPs' opinion that they are improving quality and efficiency of care when executing disease management, presence of a good quality network between actors involved prior to the start of disease management, working in a health centre, and performing sideline activities besides their daily activities as GPs. The main factors predicting a negative attitude are: GPs' opinion that the investment-time is too high, lack of reimbursement for disease management activities, working in a solo practice, and not performing any sideline activities beside their daily activities as GP. CONCLUSIONS: The factors predicting a negative attitude of Dutch GPs towards disease management dominate the factors predicting a positive attitude. The arguments in favour of disease management are matters of belief, for example concerning improvements in the quality of care, while arguments against are more concrete barriers e.g. high workload and financial reimbursement. Placed on the innovation timeline, the 10.4% participation might be taken to represent the start of a trend

A disease management programme for patients with diabetes mellitus is associated with improved quality of care within existing budgets

Aim  To assess the impact of a disease management programme for patients with diabetes mellitus (Type 1 and Type 2) on cost-effectiveness, quality of life and patient self-management. By organizing care in accordance with the principles of disease management, it is aimed to increase quality of care within existing budgets. Methods  Single-group, pre-post design with 2-year follow-up in 473 patients. Results  Substantial significant improvements in glycaemic control, health-related quality of life (HRQL) and patient self-management were found. No significant changes were detected in total costs of care. The probability that the disease management programme is cost-effective compared with usual care amounts to 74%, expressed in an average saving of 117 per additional life year at 5% improved HRQL. Conclusion  Introduction of a disease management programme for patients with diabetes is associated with improved intermediate outcomes within existing budgets. Further research should focus on long-term cost-effectiveness, including diabetic complications and mortality, in a controlled setting or by using decision-analytic modelling technique

Costs of quality management systems in long-term care organizations: an exploration.

The article describes a method for measuring and reporting the costs of quality management in 11 long-term care organizations (nursing homes, home health care organizations, and homes for the elderly) and a national survey in 489 organizations providing long-term care. Site visits and a questionnaire were used to measure the existence of quality management (QM) activities and investigate the costs per QM activity in more detail. Health care organizations differentiate between regular activities and QM activities. The costs of QM activities were found to vary between 0.3% and 3.5% of the budget in three nursing homes. An extrapolation of the costs of QM activities to the entire sector shows that the long-term care sector spent between 0.8% and 3.5% of the overall budget for QM in 1999. The costs of developing and implementing QM activities are higher than the costs of monitoring. Most long-term care organizations have no insight into failure costs (i.e. the costs of quality deviations). This makes it impossible for health care organizations to draw conclusions about the cost-effectiveness of QM. (aut. ref.

Exploratief onderzoek naar kwaliteitskosten in de thuiszorg.

De 3 deelnemende thuiszorginstellingen hebben tussen de 0.09% en 0.6% van hun budget besteed aan het ontwikkelen, implementeren en onderhouden van een kwaliteitssysteem. Er wordt meer geld besteed aan preventiekosten dan aan beoordelingskosten, maar voor een deel is de hoogte van de beoordelingskosten niet bekend. Een groot deel van de kosten ging bij een instelling zitten in het aantrekken van een externe adviseur, terwijl de andere instelling een grootschalig introductieprogramma heeft opgezet. De kosten van verbeterprojecten zijn moeilijk in kaart te brengen, omdat het traceren van kosten en baten in het kader van kwaliteitsbeleid nog onvoldoende vorm heeft gekregen, of omdat de instelling geen verbeterprojecten uitvoert. Het is duidelijk dat elke activiteit, procedure of project geld kost doordat medewerkers tijd eraan besteden die anders op een andere manier besteed had kunnen worden. Het is vanuit dat oogpunt van belang om voor elke activiteit en procedure na te gaan of deze de gewenste resultaten oplevert. Uit de gegevens blijkt tot nu toe geen duidelijke relatie tussen de aanwezigheid van een kwaliteitssysteem en het oordeel van cliënten, één van de resultaatsgebieden binnen kwaliteitsmanagement. Binnen dit onderzoek is niet gekeken of de aanwezigheid van een kwaliteitssysteem een positief effect heeft op andere resultaatsgebieden zoals bijvoorbeeld de tevredenheid van medewerkers, de beheersbaarheid van de organisatie of klinische uitkomsten. Eveneens is geen zicht gekregen op de relatie tussen preventie-/beoordelingskosten en herstelkosten, omdat de instellingen weinig inzicht hebben in herstelkosten. In theorie is het dalen van herstelkosten op grond van minder fouten en het niet nakomen van afspraken een positief effect van kwaliteitssystemen

Enterprise resource planning for hospitals

Integrated hospitals need a central planning and control system to plan patients’ processes and the required capacity. Given the changes in healthcare one can ask the question what type of information systems can best support these healthcare delivery organizations. We focus in this review on the potential of enterprise resource planning (ERP) systems for healthcare delivery organizations. First ERP systems are explained. An overview is then presented of the characteristics of the planning process in hospital environments. Problems with ERP that are due to the special characteristics of healthcare are presented. The situations in which ERP can or cannot be used are discussed. It is suggested to divide hospitals in a part that is concerned only with deterministic processes and a part that is concerned with non-deterministic processes. ERP can be very useful for planning and controlling the deterministic processes