Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study.

Background: Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups.

Methods: An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals.

Relevance of hypersexual disorder to family medicine and primary care as a complex multidimensional chronic disease construct.

Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the absence of solid evidence on prevalence, causes, empirically validated diagnostic criteria, instruments for diagnosis, consistent guidelines on treatment options, medical and psychosocial consequences, and type of caregivers that need to be involved, HD remains a controversial and relatively poorly understood chronic disease construct. The role of family medicine in the detection, treatment, and followup of HD is not well studied.

A theoretical lens for revealing the complexity of chronic care.

The increasing prevalence of co-occurring multiple chronic conditions in an aging population has influenced the debate on complexity in chronic care and nowadays provides an impetus to the reform of numerous health systems. This article presents a theoretical lens for understanding the complexity of chronic care based on research and debate conducted in the context of multiple quality improvement programs over the last five years in Belgium and The Netherlands. We consider four major components of complexity in chronic care against a background of complex adaptive systems: (1) case (patient) complexity; (2) care complexity; (3) quality assessment complexity; and (4) health systems complexity.

Reported barriers to evaluation in chronic care: experiences in six European countries.

Introduction: The growing movement of innovative approaches to chronic disease management in Europe has not been matched by a corresponding effort to evaluate them. This paper discusses challenges to evaluation of chronic disease management as reported by experts in six European countries.

Methods: We conducted 42 semi-structured interviews with key informants from Austria, Denmark, France, Germany, The Netherlands and Spain involved in decision-making and implementation of chronic disease management approaches.

Co-ordination and management of chronic conditions in Europe: the role of primary care--position paper of the European Forum for Primary Care.

Healthcare systems in Europe struggle with inadequate co-ordination of care for people with chronic conditions. Moreover, there is a considerable evidence gap in the treatment of chronic conditions, lack of self-management, variation in quality of care, lack of preventive care, increasing costs for chronic care, and inefficient use of resources. In order to overcome these problems, several approaches to improve the management and co-ordination of chronic conditions have been developed in European healthcare systems.

Critical appraisal of the literature on economic evaluations of substitution of skills between professionals: a systematic literature review.

Objective: Substitution of skills has been introduced to increase health service efficiency, but little evidence is available about its cost-effectiveness. This systematic review aims to identify economic evaluations of substitution between professionals, to assess the quality of the study methods applied and to value the results for decision making.

Methods: Publications between January 1996 and November 2006 were searched in Medline, Cochrane, Cinahl, database of Health Technology Assessments, EPOC and Embase.

Cost-utility of a disease management program for patients with asthma.

Objectives: The long-term cost-utility of a disease management program (DMP) for adults with asthma was assessed compared to usual care.

Methods: A DMP for patients with asthma has been developed and implemented in the region of Maastricht (The Netherlands). By integrating care, the program aims to continuously improve quality of care within existing budgets.

Health technology assessment of asthma disease management programs.

Purpose Of Review: To provide a critical opinion on the extent to which asthma disease management programs currently improve the effectiveness and efficiency of care and directions for future policy and research.

Recent Findings: The methodological quality of health technology assessment of asthma disease management programs remains moderate. Asthma disease management programs are predominantly educational and organizational in nature and focus either on children or on adults.

Evaluation of a regional disease management programme for patients with asthma or chronic obstructive pulmonary disease.

Objective: To assess the impact of a population-based disease management programme for adult patients with asthma or chronic obstructive pulmonary disease (COPD) on process measures, intermediate outcomes, and endpoints of care.

Design: Quasi-experimental design with 12-month follow-up.

Setting: Region of Maastricht (the Netherlands) including university hospital and 16 general practices.

Are we measuring what matters in health technology assessment of disease management? Systematic literature review.

Objectives: An overview was produced of indicators currently used to assess disease management programs and, based on these findings, provide a framework regarding sets of indicators that should be used when taking the aims and types of disease management programs into account.

Methods: A systematic literature review was performed.

Results: Thirty-six studies met the inclusion criteria.