Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.
BMC Health Serv Res. 2011 Jan 10;11:6. doi: 10.1186/1472-6963-11-6.
Disease management programmes (DMPs) have been developed to improve effectiveness and economic efficiency within chronic care delivery by combining patient-related, professional-directed, and organisational interventions. The benefits of DMPs within different settings, patient groups, and versions remain unclear. In this article we propose a protocol to evaluate a range of current DMPs by capturing them in a single conceptual framework, employing comparable structure, process, and outcome measures, and combining qualitative and quantitative research methods.
To assess DMP effectiveness a practical clinical trial will be conducted. Twenty-two disease management experiments will be studied in various Dutch regions consisting of a variety of collaborations between organisations and/or professionals. Patient cohorts include those with cardiovascular diseases, chronic obstructive pulmonary disease, diabetes, stroke, depression, psychotic diseases, and eating disorders. Our methodological approach combines qualitative and quantitative research methods to enable a comprehensive evaluation of complex programmes. Process indicators will be collected from health care providers' data registries and measured via physician and staff questionnaires. Patient questionnaires include health care experiences, health care utilisation, and quality of life. Qualitative data will be gathered by means of interviews and document analysis for an in depth description of project interventions and the contexts in which DMPs are embedded, and an ethnographic process evaluation in five DMPs. Such a design will provide insight into ongoing DMPs and demonstrate which elements of the intervention are potentially (cost)-effective for which patient populations. It will also enable sound comparison of the results of the different programmes.
The study will lead to a better understanding of (1) the mechanisms of disease management, (2) the feasibility, and cost-effectiveness of a disease management approach to improving health care, and (3) the factors that determine success and failure of DMPs. Our study results will be relevant to decision makers and managers who confront the challenge of implementing and integrating DMPs into the health care system. Moreover, it will contribute to the search for methods to evaluate complex healthcare interventions.
疾病管理计划（DMP）旨在通过结合患者相关、专业指导和组织干预措施，提高慢性病治疗的有效性和经济效率。在不同环境、患者群体和版本中，DMP 的益处仍不清楚。在本文中，我们提出了一个通过将其纳入单一概念框架、采用可比的结构、过程和结果测量方法以及结合定性和定量研究方法来评估一系列当前 DMP 的方案。
为了评估 DMP 的效果，将进行一项实用的临床试验。将在荷兰不同地区研究 22 个疾病管理实验，这些实验包括组织和/或专业人员之间的各种合作。患者队列包括患有心血管疾病、慢性阻塞性肺疾病、糖尿病、中风、抑郁症、精神病和饮食失调症的患者。我们的方法学方法结合了定性和定量研究方法，以能够对复杂的计划进行全面评估。过程指标将从医疗保健提供者的数据登记中收集，并通过医生和工作人员的问卷进行测量。患者问卷包括医疗保健体验、医疗保健利用和生活质量。通过访谈和文件分析收集定性数据，以深入描述项目干预措施以及 DMP 所嵌入的环境，并在五个 DMP 中进行民族志过程评估。这种设计将提供对正在进行的 DMP 的深入了解，并展示干预措施的哪些要素对哪些患者群体具有潜在的（成本）效益。它还将能够对不同计划的结果进行合理比较。
该研究将有助于更好地理解（1）疾病管理的机制，（2）采用疾病管理方法改善医疗保健的可行性和成本效益，以及（3）决定 DMP 成功和失败的因素。我们的研究结果将与决策者和管理者相关，他们面临着实施和整合 DMP 到医疗保健系统中的挑战。此外，它将有助于寻找评估复杂医疗干预措施的方法。
