Department of Health Care Management, Technische Universität Berlin, Shared authorship: Fuchs, Henschke and Blümel have equally contributed to the article.
Dtsch Arztebl Int. 2014 Jun 27;111(26):453-63. doi: 10.3238/arztebl.2014.0453.
Disease management programs (DMPs) are intended to improve the care of persons with chronic diseases. Despite numerous studies there is no unequivocal evidence about the effectiveness of DMPs in Germany.
We conducted a systematic literature review in the MEDLINE, EMBASE, Cochrane Library, and CCMed databases. Our analysis included all controlled studies in which patients with type 2 diabetes enrolled in a DMP were compared to type 2 diabetes patients receiving routine care with respect to process, outcome, and economic parameters.
The 9 studies included in the analysis were highly divergent with respect to their characteristics and the process and outcome parameters studied in each. No study had data beyond the year 2008. In 3 publications, the DMP patients had a lower mortality than the control patients (2.3%, 11.3%, and 7.17% versus 4.7%, 14.4%, and 14.72%). In 2 publications, DMP participation was found to be associated with a mean survival time of 1044.94 (± 189.87) days, as against 985.02 (± 264.68) in the control group. No consistent effect was seen with respect to morbidity, quality of life, or economic parameters. 7 publications from 5 studies revealed positive effects on process parameters for DMP participants.
The observed beneficial trends with respect to mortality and survival time, as well as improvements in process parameters, indicate that DMPs can, in fact, improve the care of patients with diabetes. Further evaluation is needed, because some changes in outcome parameters (an important indicator of the quality of care) may only be observable over a longer period of time.
疾病管理计划（DMP）旨在改善慢性病患者的护理。尽管有大量研究，但德国仍缺乏关于 DMP 有效性的明确证据。
我们在 MEDLINE、EMBASE、Cochrane 图书馆和 CCMed 数据库中进行了系统文献综述。我们的分析包括所有将 2 型糖尿病患者纳入 DMP 的对照研究，这些患者与接受常规护理的 2 型糖尿病患者相比，在过程、结果和经济参数方面进行了比较。
纳入分析的 9 项研究在其特征以及每项研究中研究的过程和结果参数方面存在很大差异。没有一项研究的数据超过 2008 年。在 3 篇出版物中，DMP 患者的死亡率低于对照组患者（2.3%、11.3%和 7.17%比 4.7%、14.4%和 14.72%）。在 2 篇出版物中，DMP 参与与平均生存时间 1044.94（±189.87）天相关，而对照组为 985.02（±264.68）天。在发病率、生活质量或经济参数方面没有观察到一致的效果。来自 5 项研究的 7 篇出版物揭示了 DMP 参与者的过程参数的有益趋势。
死亡率和生存时间观察到的有利趋势，以及过程参数的改善，表明 DMP 确实可以改善糖尿病患者的护理。需要进一步评估，因为一些结局参数（护理质量的重要指标）的变化可能仅在较长时间内才能观察到。
