Adoption of disease management model for diabetes in region of Maastricht

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Abstract
Chronic diseases and associated conditions will always pose a challenge to healthcare systems. New healthcare models are being introduced in Western countries in response to a set of problems that are evident to some degree in all health services—for example, uncoordinated arrangements for delivering care, bias towards acute treatment, neglect of preventive care, and inappropriate treatment.1 These models take account of the pressure on quality and costs of chronic care and originate from the overlapping approaches of integrated care (United States) and shared care (western Europe). 2 3 In the Netherlands, shared care models have acted as a precursor of the recently introduced concept of disease management. Although several disease management initiatives are emerging, the model is not being adopted as fast as might be expected from the benefits that are claimed to result from it.4 In this article we describe the process of moving from a shared care model to a disease management model by considering recent developments in diabetes care in the region of Maastricht. We also describe the use of health technology assessment to evaluate the model. #### Summary points The concepts of integrated care and shared care can be regarded, in the Netherlands at least, as the precursor of disease management Implementation of a shared care model for diabetes in the region of Maastricht ensured that necessary conditions were met for a disease management model Widespread use of disease management models is hampered by lack of evidence Evidence from health technology assessment is necessary to justify large scale use of disease management models but will not be sufficient by itself Shared care for patients with stable diabetes mellitus type 2 who were receiving care from an endocrinologist in an outpatient clinic was implemented in the region of Maastricht in 1997. Two changes were made from usual care: …