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Effectiveness of the German disease management programs: quasi-experimental analyses assessing the population-level health impact. BMC Public Health 2021; 21:2092. [PMID: 34781907 PMCID: PMC8591814 DOI: 10.1186/s12889-021-12050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background In 2002–2003 disease management programs (DMPs) for type 2 diabetes and coronary heart disease were introduced in Germany to improve the management of these conditions. Today around 6 million Germans aged 56 and older are enrolled in one of the DMPs; however, their effect on health remains unclear. Methods We estimated the impact of German DMPs on circulatory and all-cause mortality using a synthetic control study. Specifically, using routinely available data, we compared pre and post-intervention trends in mortality of individuals aged 56 and older for 1998–2014 in Germany to trends in other European countries. Results Average circulatory and all-cause mortality in Germany and the synthetic control was 1.63 and 3.24 deaths per 100 persons. Independent of model choice, circulatory and all-cause mortality decreased non-significantly less in Germany than in the synthetic control; for the model with a 3 year time lag, for example, by 0.12 (95%-CI: − 0.20; 0.44) and 0.22 (95%-CI: − 0.40; 0.66) deaths per 100 persons, respectively. Further main analyses, as well as sensitivity and subgroup analyses supported these results. Conclusions We observed no effect on circulatory or all-cause mortality at the population-level. However, confidence intervals were wide, meaning we could not reject the possibility of a positive effect. Given the substantial costs for administration and operation of the programs, further comparative effectiveness research is needed to clarify the value of German DMPs for type 2 diabetes and CHD. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12050-7.
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Stegbauer C, Falivena C, Moreno A, Hentschel A, Rosenmöller M, Heise T, Szecsenyi J, Schliess F. Costs and its drivers for diabetes mellitus type 2 patients in France and Germany: a systematic review of economic studies. BMC Health Serv Res 2020; 20:1043. [PMID: 33198734 PMCID: PMC7667793 DOI: 10.1186/s12913-020-05897-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/03/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Type 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources from both patients and national economies to sustain direct costs of the treatment of type 2 diabetes and its complications and indirect costs related to work loss and wages. More recently, there are innovations based on remote control and personalised programs that promise a more cost-effective diabetes management while reducing diabetes-related complications. In such a context, this work attempts to update cost analysis reviews on type 2 diabetes, focusing on France and Germany, in order to explore most significant cost drivers and cost-saving opportunities through innovations in diabetes care. Although both countries approach care delivery differently, France and Germany represent the primary European markets for diabetes technologies. METHODS A systematic review of the literature listed in MEDLINE, Embase and EconLit has been carried out. It covered interventional, observational and modelling studies on expenditures for type 2 diabetes management in France or Germany published since 2012. Included articles were analysed for annual direct, associated and indirect costs of type 2 diabetes patients. An appraisal of study quality was performed. Results were summarised narratively. RESULTS From 1260 records, the final sample was composed of 24 papers selected according to predefined inclusion/exclusion criteria. Both France and Germany revealed a predominant focus on direct costs. Comparability was limited due to different study populations and cost categories used. Indirect costs were only available in Germany. According to prior literature, reported cost drivers are hospitalisation, prescriptions, higher HbA1c and BMI, treatment with insulin and complications, all indicators of disease severity. The diversity of available data and included costs limits the results and may explain the differences found. CONCLUSIONS Complication prevention and glycaemic control are widely recognized as the most effective ways to control diabetes treatment costs. The value propositions of self-based supports, such as hybrid closed-loop metabolic systems, already implemented in type 1 diabetes management, are the key points for further debates and policymaking, which should involve the perspectives of caregivers, patients and payers.
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Affiliation(s)
- Constance Stegbauer
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Lower Saxony, Germany.
| | - Camilla Falivena
- Health & Not for Profit Division, CERGAS, SDA Bocconi School of Management Governments, Via Sarfatti, 10, Milan, 20136, Italy
| | - Ariadna Moreno
- CRHIM - Center for Research in Healthcare Innovation Management, IESE Business School - University of Navarra, C. d'Arnús i de Garí, 3-7, Barcelona, 08034, Catalonia, Spain
| | - Anna Hentschel
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Lower Saxony, Germany
| | - Magda Rosenmöller
- CRHIM - Center for Research in Healthcare Innovation Management, IESE Business School - University of Navarra, C. d'Arnús i de Garí, 3-7, Barcelona, 08034, Catalonia, Spain
| | - Tim Heise
- Profil, Hellersbergstr. 9, Neuss, 41460, North Rhine-Westphalia, Germany
| | - Joachim Szecsenyi
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Lower Saxony, Germany
| | - Freimut Schliess
- Profil, Hellersbergstr. 9, Neuss, 41460, North Rhine-Westphalia, Germany
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Kirsch F, Becker C, Schramm A, Maier W, Leidl R. Patients with coronary artery disease after acute myocardial infarction: effects of continuous enrollment in a structured Disease Management Program on adherence to guideline-recommended medication, health care expenditures, and survival. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:607-619. [PMID: 32006188 PMCID: PMC7214389 DOI: 10.1007/s10198-020-01158-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 01/06/2020] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Acute myocardial infarction (AMI) carries increased risk of mortality and excess costs. Disease Management Programs (DMPs) providing guideline-recommended care for chronic diseases seem an intuitively appealing way to enhance health outcomes for patients with chronic conditions such as AMI. The aim of the study is to compare adherence to guideline-recommended medication, health care expenditures and survival of patients enrolled and not enrolled in the German DMP for coronary artery disease (CAD) after an AMI from the perspective of a third-party payer over a follow-up period of 3 years. METHODS The study is based on routinely collected data from a regional statutory health insurance fund (n = 15,360). A propensity score matching with caliper method was conducted. Afterwards guideline-recommended medication, health care expenditures, and survival between patients enrolled and not enrolled in the DMP were compared with generalized linear and Cox proportional hazard models. RESULTS The propensity score matching resulted in 3870 pairs of AMI patients previously and continuously enrolled and not enrolled in the DMP. In the 3-year follow-up period the proportion of days covered rates for ACE-inhibitors (60.95% vs. 58.92%), anti-platelet agents (74.20% vs. 70.66%), statins (54.18% vs. 52.13%), and β-blockers (61.95% vs. 52.64%) were higher in the DMP group. Besides that, DMP participants induced lower health care expenditures per day (€58.24 vs. €72.72) and had a significantly lower risk of death (HR: 0.757). CONCLUSION Previous and continuous enrollment in the DMP CAD for patients after AMI is a promising strategy as it enhances guideline-recommended medication, reduces health care expenditures and the risk of death.
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Affiliation(s)
- Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Christian Becker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anja Schramm
- AOK Bayern, Service Center of Health Care Management, Regensburg, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany
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Gansen FM. Health economic evaluations based on routine data in Germany: a systematic review. BMC Health Serv Res 2018; 18:268. [PMID: 29636046 PMCID: PMC5894241 DOI: 10.1186/s12913-018-3080-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 03/28/2018] [Indexed: 02/02/2023] Open
Abstract
Background Improved data access and funding for health services research have promoted the application of routine data to measure costs and effects of interventions within the German health care system. Following the trend towards real world evidence, this review aims to evaluate the status and quality of health economic evaluations based on routine data in Germany. Methods To identify relevant economic evaluations, a systematic literature search in the databases PubMed and EMBASE was complemented by a manual search. The included studies had to be full economic evaluations using German routine data to measure either costs, effects, or both. Study characteristics were assessed with a structured template. Additionally, the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) were used to measure quality of reporting. Results In total, 912 records were identified and 35 studies were included in the further analysis. The majority of these studies was published in the past 5 years (n = 27, 77.1%) and used insurance claims data as a source of routine data (n = 30, 85.7%). The most common method used for handling selection bias was propensity score matching. With regard to the reporting quality, 42.9% (n = 15) of the studies satisfied at least 80% of the criteria on the CHEERS checklist. Conclusions This review confirms that routine data has become an increasingly common data source for health economic evaluations in Germany. While most studies addressed the application of routine data, this analysis reveals deficits in considering methodological particularities and in reporting quality of economic evaluations based on routine data. Nevertheless, this review demonstrates the overall potential of routine data for economic evaluations. Electronic supplementary material The online version of this article (10.1186/s12913-018-3080-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fabia Mareike Gansen
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Grazer Str. 2a, 28359, Bremen, Germany.
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Li D, Elliott T, Klein G, Ur E, Tang TS. Diabetes Nurse Case Management in a Canadian Tertiary Care Setting: Results of a Randomized Controlled Trial. Can J Diabetes 2017; 41:297-304. [DOI: 10.1016/j.jcjd.2016.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 11/16/2022]
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Kostev K, Rockel T, Jacob L. Impact of Disease Management Programs on HbA1c Values in Type 2 Diabetes Patients in Germany. J Diabetes Sci Technol 2017; 11:117-122. [PMID: 27246670 PMCID: PMC5375061 DOI: 10.1177/1932296816651633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim was to analyze the impact of disease management programs on HbA1c values in type 2 diabetes mellitus (T2DM) patients in Germany. METHODS This study included 9017 patients followed in disease management programs (DMPs) who started an antihyperglycemic treatment upon inclusion in a DMP. Standard care (SC) patients were included after individual matching (1:1) to DMP cases based on age, gender, physician (diabetologist versus nondiabetologist care), HbA1c values at baseline, and index year. The main outcome was the share of patients with HbA1c <7.5% or 6.5% after at least 6 months and less than 12 months of therapy in DMP and SC groups. Multivariate logistic regression models were fitted with HbA1c level as a dependent variable and the potential predictor (DMP versus SC). RESULTS The mean age was 64.3 years and 54.7% of the patients were men. The mean HbA1c level at baseline was equal to 8.7%. In diabetologist practices, 64.7% of DMP patients and 55.1% of SC patients had HbA1c levels <7.5%, while 23.4% of DMP patients and 16.9% of SC patients had HbA1c levels <6.5% ( P values < .001). By comparison, in general practices, 72.4% of DMP patients and 65.7% of SC patients had HbA1c levels <7.5%, while 29.0% of DMP patients and 25.4% of SC patients had HbA1c levels <6.5% ( P values < .001). DMPs increased the likelihood of HbA1c levels lower than 7.5% or 6.5% after 6 months of therapy in both diabetologist and general care practices. CONCLUSION The present study indicates that the enrollment of T2DM patients in DMPs has a positive impact on HbA1c values in Germany.
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Affiliation(s)
- Karel Kostev
- IMS Health, Frankfurt, Germany
- Karel Kostev, DMSc, PhD, IMS Health, Epidemiology, Darmstädter Landstraße 1089, 60598 Frankfurt am Main, Germany.
| | | | - Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
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Laxy M, Knoll G, Schunk M, Meisinger C, Huth C, Holle R. Quality of Diabetes Care in Germany Improved from 2000 to 2007 to 2014, but Improvements Diminished since 2007. Evidence from the Population-Based KORA Studies. PLoS One 2016; 11:e0164704. [PMID: 27749939 PMCID: PMC5066975 DOI: 10.1371/journal.pone.0164704] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/29/2016] [Indexed: 11/23/2022] Open
Abstract
Objective Little is known about the development of the quality of diabetes care in Germany. The aim of this study is to analyze time trends in patient self-management, physician-delivered care, medication, risk factor control, complications and quality of life from 2000 to 2014. Methods Analyses are based on data from individuals with type 2 diabetes of the population-based KORA S4 (1999–2001, n = 150), F4 (2006–2008, n = 203), FF4 (2013/14, n = 212) cohort study. Information on patient self-management, physician-delivered care, medication, risk factor control and quality of life were assessed in standardized questionnaires and examinations. The 10-year coronary heart disease (CHD) risk was calculated using the UKPDS risk engine. Time trends were analyzed using multivariable linear and logistic regression models adjusted for age, sex, education, diabetes duration, and history of cardiovascular disease. Results From 2000 to 2014 the proportion of participants with type 2 diabetes receiving oral antidiabetic/cardio-protective medication and of those reaching treatment goals for glycemic control (HbA1c<7%, 60% to 71%, p = 0.09), blood pressure (<140/80 mmHg, 25% to 69%, p<0.001) and LDL cholesterol (<2.6 mmol/l, 13% to 27%, p<0.001) increased significantly. However, improvements were generally smaller from 2007 to 2014 than from 2000 to 2007. Modeled 10-year CHD risk decreased from 30% in 2000 to 24% in 2007 to 19% in 2014 (p<0.01). From 2007 to 2014, the prevalence of microvascular complications decreased and quality of life increased, but no improvements were observed for the majority of indicators of self-management. Conclusion Despite improvements, medication and risk factor control has remained suboptimal. The flattening of improvements and deteriorations in quality of (self-) care since 2007 indicate that more effort is needed to improve quality of care and patient self-management. Due to selection or lead time bias an overestimation of quality of care improvements cannot be ruled out.
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Affiliation(s)
- Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- * E-mail:
| | - Gabriella Knoll
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Informatics, Biometrics and Epidemiology, Ludwig-Maximilians- Universität München, Munich, Germany
| | - Michaela Schunk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christa Meisinger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
| | - Cornelia Huth
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Laxy M, Stark R, Meisinger C, Kirchberger I, Heier M, von Scheidt W, Holle R. The effectiveness of German disease management programs (DMPs) in patients with type 2 diabetes mellitus and coronary heart disease: results from an observational longitudinal study. Diabetol Metab Syndr 2015; 7:77. [PMID: 26388948 PMCID: PMC4574141 DOI: 10.1186/s13098-015-0065-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the population-based German disease management programs (DMPs) for diabetes mellitus (DM) and coronary heart disease (CHD) are among the biggest worldwide, evidence on the effectiveness of these programs is still inconclusive or missing, particularly for high risk patients with comorbidities. The objective of this study was therefore to analyze the impact of DMPs on process and outcome parameters in patients with both, type 2 DM and CHD. METHODS Analyses are based on two postal surveys of patients from the KORA myocardial infarction registry (southern Germany) with type 2 DM and on two postal validation studies with patients' general physicians (2006, n = 312 and 2011, n = 212). The association between DMP enrollment (being enrolled in either DMP-DM or DMP-CHD) and guideline care (defined by several process indicators) at baseline (2006) and its development until follow-up (2011) was analyzed using logistic regression models accounting for the repeated measurements structure. The impact of DMP enrollment/guideline care on cumulated (quality-adjusted) life years ((QA)LYs) over a 4-year time horizon (2006-2010) was assessed using multiple linear regression methods. Logistic regression models were applied to analyze the association between DMP status and patient self-management at follow-up. RESULTS Being enrolled in a DMP was associated with better guideline care at baseline [OR = 2.3 (95 % CI 1.27-4.03)], but not at follow-up [OR = 0.80 (95 % CI 0.40-1.58); p value for time-interaction <0.01]. DMP enrollment was not significantly [+0.15 LYs (95 % CI -0.07, 0.37); +0.06 QALYs (95 % CI -0.15, 0.26)], but treatment according to guideline care significantly [+0.40 LYs (95 % CI 0.21-0.60); +0.28 QALYs (95 % CI 0.10-0.45)] associated with higher (quality-adjusted) survival over the 4-year follow-up period. DMP enrollees further reported a somewhat better self-management than patients not being enrolled into a DMP. CONCLUSIONS The results of this study concerning the effectiveness of DMPs in patients with DM and CHD are mixed, but are weakly in favor of DMPs. However, we found a clear positive impact of guideline care on quality adjusted survival in this patient group. The development of the association between DMP enrollment and guideline care over the follow-up time indicates some external effects, which should be the subject of further investigations.
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Affiliation(s)
- Michael Laxy
- />Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />German Center for Diabetes Research, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Renée Stark
- />Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Christa Meisinger
- />Helmholtz Zentrum München, Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Inge Kirchberger
- />Helmholtz Zentrum München, Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Margit Heier
- />Helmholtz Zentrum München, Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Wolfgang von Scheidt
- />Department of Internal Medicine I-Cardiology, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Rolf Holle
- />Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />German Center for Diabetes Research, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
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Fuchs S, Henschke C, Blümel M, Busse R. Disease management programs for type 2 diabetes in Germany: a systematic literature review evaluating effectiveness. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:453-63. [PMID: 25019922 DOI: 10.3238/arztebl.2014.0453] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND 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. METHOD 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Sabine Fuchs
- Department of Health Care Management, Technische Universität Berlin, Shared authorship: Fuchs, Henschke and Blümel have equally contributed to the article
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Ooi KL, Loh SI, Tan ML, Muhammad TST, Sulaiman SF. Growth inhibition of human liver carcinoma HepG2 cells and α-glucosidase inhibitory activity of Murdannia bracteata (C.B. Clarke) Kuntze ex J.K. Morton extracts. JOURNAL OF ETHNOPHARMACOLOGY 2015; 162:55-60. [PMID: 25554642 DOI: 10.1016/j.jep.2014.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/26/2014] [Accepted: 12/20/2014] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The juice of the entire fresh herb and infusion of dried sample of Murdannia bracteata are consumed to treat liver cancer and diabetes in Malaysia. However, no scientific evidence of these bioactivities has been reported. MATERIALS AND METHODS To verify the therapeutic potentials of sequential extracts and infusion of this plant by determining its cytotoxicity against human liver carcinoma HepG2 cells and α-glucosidase inhibitory activity. The cytotoxic activities of the extracts against HepG2 were determined using a methylene blue assay, and an α-glucosidase inhibitory assay was used to assess anti-diabetic activity. The molecular basis of the anti-hepatocellular carcinoma activity of the most active extract was determined using RT-PCR. Chemical profiling of the most active extract was performed using GC-MS and UPLC analyses. RESULTS The results obtained from the cytotoxic screening revealed the dose-dependent growth inhibition of the HepG2 cells by only the hexane extract, with an EC50 value of 37.17±1.00 µg/ml. The HepG2 cell death was found to be apoptotic in nature and based on the significant biphasic induction of caspase-3, suggesting that the extract inhibited cell growth through a caspase-3-dependent pathway. The hexane extract also displayed α-glucosidase inhibitory activity, with an EC50 of 117.04±2.34 µg/ml. GC-MS analysis revealed that α-tocopherol was the major volatile compound in the hexane extract, and two phenolics (apigenin and caffeic acid derivatives) were detected using UPLC. CONCLUSIONS Based on various published reports, it could be suggested that α-tocopherol and apigenin derivatives might be involved in the apoptosis-based cytotoxicity of the active extract of this plant against HepG2 carcinoma cells. The effects of this plant in the treatment of diabetes can be related to the presence of α-glucosidase inhibitors, such as the caffeic acid derivative identified in the active extract.
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Affiliation(s)
- Kheng Leong Ooi
- School of Biological Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Suh In Loh
- School of Biological Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Mei Lan Tan
- Advanced Medical & Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Penang, Malaysia
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Chao J, Yang L, Xu H, Yu Q, Jiang L, Zong M. The effect of integrated health management model on the health of older adults with diabetes in a randomized controlled trial. Arch Gerontol Geriatr 2015; 60:82-8. [DOI: 10.1016/j.archger.2014.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/04/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
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The long-term effect of community-based health management on the elderly with type 2 diabetes by the Markov modeling. Arch Gerontol Geriatr 2014; 59:353-9. [PMID: 24929252 DOI: 10.1016/j.archger.2014.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 05/04/2014] [Accepted: 05/08/2014] [Indexed: 11/23/2022]
Abstract
The aim of this study was to assess the long-term effects of community-based health management on elderly diabetic patients using a Markov model. A Markov decision model was used to simulate the natural history of diabetes. Data were obtained from our randomized trials of elderly with type 2 diabetes and from the published literature. One hundred elderly patients with type 2 diabetes were randomly allocated to either the management or the control group in a one-to-one ratio. The management group participated in a health management program for 18 months in addition to receiving usual care. The control group only received usual care. Measurements were performed on both groups at baseline and after 18 months. The Markov model predicted that for every 1000 diabetic patients receiving health management, approximately 123 diabetic patients would avoid complications, and approximately 37 would avoid death over the next 13 years. The results suggest that the health management program had a positive long-term effect on the health of elderly diabetic patients. The Markov model appears to be useful in health care planning and decision-making aimed at reducing the financial and social burden of diabetes.
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Ceriello A, Barkai L, Christiansen JS, Czupryniak L, Gomis R, Harno K, Kulzer B, Ludvigsson J, Némethyová Z, Owens D, Schnell O, Tankova T, Taskinen MR, Vergès B, Weitgasser R, Wens J. Diabetes as a case study of chronic disease management with a personalized approach: the role of a structured feedback loop. Diabetes Res Clin Pract 2012; 98:5-10. [PMID: 22917639 DOI: 10.1016/j.diabres.2012.07.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/10/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
As non-communicable or chronic diseases are a growing threat to human health and economic growth, political stakeholders are aiming to identify options for improved response to the challenges of prevention and management of non-communicable diseases. This paper is intended to contribute ideas on personalized chronic disease management which are based on experience with one major chronic disease, namely diabetes mellitus. Diabetes provides a pertinent case of chronic disease management with a particular focus on patient self-management. Despite advances in diabetes therapy, many people with diabetes still fail to achieve treatment targets thus remaining at risk of complications. Personalizing the management of diabetes according to the patient's individual profile can help in improving therapy adherence and treatment outcomes. This paper suggests using a six-step cycle for personalized diabetes (self-)management and collaborative use of structured blood glucose data. E-health solutions can be used to improve process efficiencies and allow remote access. Decision support tools and algorithms can help doctors in making therapeutic decisions based on individual patient profiles. Available evidence about the effectiveness of the cycle's constituting elements justifies expectations that the diabetes management cycle as a whole can generate medical and economic benefit.
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Affiliation(s)
- Antonio Ceriello
- Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Hospital Clínic Barcelona, Barcelona, Spain.
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[Health economic evaluation based on administrative data from German health insurance]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:668-74. [PMID: 22526855 DOI: 10.1007/s00103-012-1476-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although the quality of administrative data of German health insurance is relatively good, administrative data are rarely used for the purpose of health economic evaluations in Germany. Health economic evaluations in Germany have so far mainly been performed based on primary data while in other countries the use of secondary data is quite common. The objective of the article is to give an introduction into the possibilities of performing health economic evaluations based on administrative data. First, we show that German health insurance have data sets that allow the follow-up of patients across all sectors of health care. Subsequently, characteristics of primary data and administrative data of health insurance for the purpose of health economic evaluations are compared. Finally we present an overview of recently performed health economic evaluations based on administrative data in Germany and conclude with lessons from other countries on the use of administrative data and implications for Germany.
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Coburn KD, Marcantonio S, Lazansky R, Keller M, Davis N. Effect of a community-based nursing intervention on mortality in chronically ill older adults: a randomized controlled trial. PLoS Med 2012; 9:e1001265. [PMID: 22815653 PMCID: PMC3398966 DOI: 10.1371/journal.pmed.1001265] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/29/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improving the health of chronically ill older adults is a major challenge facing modern health care systems. A community-based nursing intervention developed by Health Quality Partners (HQP) was one of 15 different models of care coordination tested in randomized controlled trials within the Medicare Coordinated Care Demonstration (MCCD), a national US study. Evaluation of the HQP program began in 2002. The study reported here was designed to evaluate the survival impact of the HQP program versus usual care up to five years post-enrollment. METHODS AND FINDINGS HQP enrolled 1,736 adults aged 65 and over, with one or more eligible chronic conditions (coronary artery disease, heart failure, diabetes, asthma, hypertension, or hyperlipidemia) during the first six years of the study. The intervention group (n = 873) was offered a comprehensive, integrated, and tightly managed system of care coordination, disease management, and preventive services provided by community-based nurse care managers working collaboratively with primary care providers. The control group (n = 863) received usual care. Overall, a 25% lower relative risk of death (hazard ratio [HR] 0.75 [95% CI 0.57-1.00], p = 0.047) was observed among intervention participants with 86 (9.9%) deaths in the intervention group and 111 (12.9%) deaths in the control group during a mean follow-up of 4.2 years. When covariates for sex, age group, primary diagnosis, perceived health, number of medications taken, hospital stays in the past 6 months, and tobacco use were included, the adjusted HR was 0.73 (95% CI 0.55-0.98, p = 0.033). Subgroup analyses did not demonstrate statistically significant interaction effects for any subgroup. No suspected program-related adverse events were identified. CONCLUSIONS The HQP model of community-based nurse care management appeared to reduce all-cause mortality in chronically ill older adults. Limitations of the study are that few low-income and non-white individuals were enrolled and implementation was in a single geographic region of the US. Additional research to confirm these findings and determine the model's scalability and generalizability is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01071967. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Kenneth D Coburn
- Health Quality Partners, Doylestown, Pennsylvania, United States of America.
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