Effectiveness of the German disease management programs: quasi-experimental analyses assessing the population-level health impact

BMC Public Health

Jacob Burns¹  Michael Laxy²  Christoph Kurz³ 

[1] Department of Sport and Health Sciences, Technical University of Munich Georg-Brauchle-Ring, 60/62, 80992, Munich, Germany;Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich Marchioninistrasse 17, 80336, Munich, Germany;Pettenkofer School of Public Health, Munich, Germany;Department of Sport and Health Sciences, Technical University of Munich Georg-Brauchle-Ring, 60/62, 80992, Munich, Germany;Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany;Munich School of Management and Munich Center of Health Sciences, LMU Munich, Munich, Germany;Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany;

关键词: Disease management;    Program evaluation;    Diabetes mellitus, type 2;    Coronary disease;    Mortality;   

DOI  :  10.1186/s12889-021-12050-7

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsWe 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.ResultsAverage 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.ConclusionsWe 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.

【 授权许可】

CC BY