Disease Management in the Dutch Context

Abstract

This book explores the extent to which ten characteristics of the concept of disease management are advisable in the long-term for certain types of patient care in the Netherlands. The care in mind for this concept covers certain patient populations as well as a number of health problems. For this purpose, the authors have taken as their starting point the following definition of disease management: the programmatical and systematic approach of specific diseases and health problems by using the management instruments that aim at the advancement of quality and efficiency. This definition is based on the literature study that was carried out by C. Spreeuwenberg for his research into the material covered in the first chapter. The ten characteristics of disease management that were derived from the general literature by the aforementioned author are as follows: 1. relates to one health problem and is aimed at clearly-defined patient populations and sub-populations 2. methodological education and the advancement of self-management 3. orientation on the integration of the various parts of the care processes including preventive interventions 4. disease management protocols that are based on evidence-based diagnostics and treatment 5. classification of patients in clinical pathways based on sub-characteristics 6. substitution of care from physicians to nurses 7. use of information and communication technology 8. focus on the use of a range of management instruments such as benchmarking and feedback 9. large-scale and a robust organizational structure 10. direction and funding coming from a central point The characteristics are thus classified according to patient care (characteristics 1 through 5) organization of the patient care (characteristics 6 and 7) and the management of patient care (characteristics 8 through 10). The patient populations that were studied were those of cystic fibrosis (chapter 2), diabetes (chapter 3), depression (chapter 4), heart failure (chapter 5), and palliative patients (chapter 6). The choice for these patient populations was made by representatives of the Dutch Council for the Chronically Ill and Disabled (CG Raad). The idea was to cover a wide range of disorders affecting the young (cystic fibrosis) to the old (heart failure, palliative care) to psychiatric (depression) and somatic illnesses (other patient populations) and on the common disorders (diabetes, heart failure) and less common disorders (cystic fibrosis, palliative care). Authors were sought with a wide range of expertise on the development of integrated care for the patient population concerned. They used knowledge from five sources: 1) their own personal experience and expertise (see author information in appendix II), 2) recent published articles covering the period 1999-2004, specifically searched through Pubmed and Google; 3) the travel reports of Marianne Acampo who visited one location per patient group in the United States, 4) expert meetings in the spring of 2004 whereby leading care professionals for each patient population, project leaders and policy-makers in the area of integrated care in the Netherlands were present, and, 5) individual analytical and judgemental skills. On the basis of this last-mentioned factor, the authors reached their conclusions on whether or not disease management should eventually be introduced in the Netherlands for their respective patient populations. In short, their answer was: Yes, disease management is a desirable concept but only if…