Economic evaluation of a diabetes disease management programme with a central role for the diabetes nurse specialist
DOI:
https://doi.org/10.1002/edn.79Keywords:
Diabetes nurse specialist, multidisciplinary team, disease management programme, economic evaluationAbstract
AbstractBackground: In the region of Maastricht, The Netherlands, a disease management programme (DMP) for patients with diabetes mellitus was implemented. The programme aims to improve quality of care within existing budgets. To achieve this, diabetes nurse specialists (DNSs) were given a central role within a multidisciplinary team of care providers. This study describes the cost-effectiveness of this approach.
Aim: To measure the incremental cost-effectiveness of a diabetes DMP, with a central role for the diabetes nurse specialist, in comparison to usual diabetes care.
Methods: Within the DMP, patients with low, medium and high complexities of care are cared for by general practitioners, DNSs and endocrinologists, respectively. The DNSs independently treat patients assigned to them and pay special attention to extensive self-management education. A quasi-experimental trial with two-year follow-up (n=473) was undertaken to measure the cost-effectiveness of the DMP compared with usual care.
Results: A total of 23% of patients were assigned to the GP, 66% to the DNS and 10% to the endocrinologist. Statistical significant improvements in glycaemic control, health-related quality of life, compliance and most aspects of self-care behaviour were found. No statistically significant changes were found concerning total costs of care. All improvements were greatest in patients assigned to DNS.
Conclusion: A DMP in which DNSs play a central role is associated with improved quality of care within existing budgets. Patients assigned to DNS benefit most, indicating that the central role of DNS in the diabetes DMP is one of its critical success factors.
Downloads
References
Vanderlaan R, Kolodny V. The use of a programmatic approach by clinical nurse specialists to promote a change in clinical practice. Perspectives 1989; 13: 6–11.
World Health Organization. Innovative Care for Chronic Conditions: building blocks for action. Geneva: World Health Organization 2002 http://www.who.int/diabetesactiononline/about/icccreport/en/index.html [Accessed 2 April 2007].
Norris SL, Olson DE. Implementing evidence-based diabetes care in geriatric populations. The chronic care model. Geriatrics 2004; 59: 35–39.
Ryan JW. Collaboration of the nurse practitioner and physician in long-term care. Lippincotts Prim Care Pract 1999; 3: 127–134.
Vrijhoef HJ, Diederiks JP, Spreeuwenberg C. Effects on quality of care for patients with NIDDM or COPD when the specialised nurse has a central role: a literature review. Patient Educ Couns 2000; 41: 243–250.
Ovhed I, Johansson E, Odeberg H, Rastam L. A comparison of two different team models for treatment of diabetes mellitus in primary care. Scand J Caring Sci 2000; 14: 253–258.
Vrijhoef HJM, Diederiks JPM, Spreeuwenberg C, Wolffenbuttel BHR. Substitution model with central role for nurse specialist is justified in the care for stable type 2 diabetic outpatients. J Adv Nursing 2001; 36: 546–555;.
Renders CM, Valk GD, Griffin SJ, et aL. Interventions to improve the management of diabetes in primary care, outpatient, and community settings. Diabetes Care 2001; 24: 1821–1833.
Norris SL, Nichols PJ, Caspersen CJ, et aL The effectiveness of disease and case management for people with diabetes. Am J Prev Med 2002; 22: 15–38.
Wilson C, Curtis J, Lipke S, et al. Nurse case manager effectiveness and case load in a large clinical practice: implications for workforce development. Diab Med 2005; 22: 1116–1120.
Vrijhoef HJ, Spreeuwenberg C, Eijkelberg IM, et aL Adoption of disease management model for diabetes in region of Maastricht. BMJ 2001; 323: 983–985.
Knight K. Badamgarav E, Henning JM, et al. A systematic review of diabetes disease management programs. Am J Manag Care 2005; 11:242–250.
Davidson MB. The effect of disease management programs for patients with diabetes mellitus on processes and outcomes of care. Am J Manag Care 2005; 11: 585.
Bodenheimer T, MacGregor K, Stothart N. Nurses as leaders in chronic care. BMJ2005;330: 612–613.
Davidson MB, Castellanos M, Duran P, Karlan V. Effective diabetes care by a registered nurse following treatment algorithms in a minority population. Am J Manag Care 2006; 12: 226–232.
Holtz-Eakin D. An analysis of the literature on disease management programs. Washington, DC: US Congressional Budget Office 2004. http://www.cbo.gov/showdoc.cfm?index=59098csequence=0 [Accessed 2 April 2007].
Disease Management Association of America. http://www.dmaa.org [Accessed 2 April 2007].
Cook TD, Campbell DT. Quasi-experimentation: design and analysis issues in field settings. Chicago: Rand McNally College Publishing 1979.
American Diabetes Association. Clinical practice guidelines 2003. Diab Care 2003; 26 (Suppl 1): S1–S156.
Dutch College of General Practitioners (Nederlands Huisartsen Genootschap). http://nhg.artsennet.nl/upload/104/standaarden/M01/std.htm4 [Accessed 2 April 2007] (in Dutch) .
Dutch Diabetes Federation (Nederlandse Diabetes Federatie). http://www.diabetes-federatie.nl/publicaties.htm [Accessed 2 April 2007] (in Dutch).
Ware JEJr, Sherbourne CD. The MOS 36-item short form health survey (SF-36) . I. Conceptual framework and item selection. Med Care 1992; 30: 473–483.
Aaronson NK, Muller M, Cohen PD, et al Translation, validation and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998; 51: 1055–1068.
Steuten LMG, Vrijhoef HJM, Severens JL, et al Are we measuring what matters in Health Technology Assessment of disease management? Int J Tech Ass Health Care 2006; 22: 47–57.
Pennings-Eerden van der LJM. Self-care behaviour in the treatment of diabetes mellitus. Theory, assessments and determinants of self-care behaviour and diabetes education. Dissertation. Utrecht: University of Utrecht 1992.
Dostenbrink JB, Koopmanschap MA, Rutten FFH. Guidelines for economic evaluations: methods and standard cost prices for economic evaluations in health care. (Handleiding MOT kostenonderzoek: methoden en standaard hostprijzen voor economische evaluaties in de gezondhei-dszorg. Geactualiseerde versie 2004.) Amstelveen: Health Insurance Council, 2004 (in Dutch).
Hollis S, Campbell E What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ 1999; 319: 670–674.
Koopmanschap MA, Rutten FF, Van Ineveld BM, Van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ 1995; 14: 171–189.
Drummond MF, O'Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. New York: Oxford University Press 1997.
Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric
approach to confidence interval estimation. Health Econ 1997;6: 327–340.
Wilson T, Linden A. Asthma disease management: regression to the mean or better? Am J Manag Care 2005; 11:136–137.
Vrijhoef HJM. Is it justifiable to treat chronic patients by nurse specialists? Evaluation of effects on quality of care. Dissertation. Maastricht: Maastricht University Press 2002.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2007 Copyright © 2007 FEND
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
