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Disease management: effectiveness and implementation

English title Disease management: effectiveness and implementation
Applicant Peytremann Bridevaux Isabelle
Number 123817
Funding scheme Ambizione
Research institution Institut Universitaire de Médecine Sociale et Préventive - IUMSP CHUV et Université de Lausanne
Institution of higher education University of Lausanne - LA
Main discipline Public Health and Health Services
Start/End 01.01.2009 - 31.12.2011
Approved amount 581'102.00
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Keywords (7)

disease management; chronic diseases; quality of care; delivery of healthcare; systematic review; evaluation studies; opinion survey

Lay Summary (English)

Lead
Lay summary
Worldwide, cardiovascular diseases, chronic lung diseases, diabetes, cancer and depressive disorders constitute a major burden for communities in terms of morbidity, disability and mortality. This burden is expected to grow with aging and increase in longevity. In addition, patients’ expectations toward healthcare are growing, and technological innovations provide new diagnostic and treatment possibilities, which increase the complexity and costs of health care. Although most care in developed countries is delivered for chronic conditions, health care systems are still mainly directed towards acute care. Furthermore, tensions occur in a context characterized by a likely future shortage in the healthcare workforce. Therefore, healthcare systems face a formidable challenge to manage chronic conditions appropriately. To address these problems, chronic disease management (DM) strategies have been developed. They are a means of reorganizing healthcare systems and medical treatment for chronic diseases. DM programs are centered on patient's needs, based on formal evidence of effectiveness, foster the coordination and the integration of health services provided by various professionals, promote the self-management by the patient and, more generally, aim at improving communication between patients and healthcare providers. Importantly, DM could contribute to improve knowledge transfer in real practice. In Switzerland, DM is in its infancy, and programs are rather scarce.Systematic reviews suggest that for diseases such as diabetes, heart failure, chronic lung diseases and depression, DM programs are effective in terms of processes and outcomes of care (e.g. improvements of diabetic patients’ glycemic control; decreased probability of hospitalization for heart failure patients). However, results of cost-effectiveness evaluations or costs studies do not always show benefits. A wider implementation of DM programs is appealing, but several questions need further investigation before generalizing these programs. While components of DM programs can improve quality of care of chronic diseases, it remains unclear how far each component is essential, and which combination of elements brings the greatest benefit to patients. Also, main weaknesses of previous studies include the short follow-up periods, the low power to detect significant effects of DM on clinically relevant outcomes, and the heterogeneity of both interventions under study and patients included. Additionally, several other issues remain unanswered, e.g., How to best handle complexity due to the coexistence of more than one chronic conditions? - What is the acceptance of such programs, and how to overcome barriers to change?The 3-year research proposal includes the following 4 projects:A) to conduct two systematic literature reviews to assess (i) the effectiveness of DM for asthma, and (ii) the specific role of, and effectiveness of teamwork in DM, across diseases. This will be done, respectively, in collaboration with the Cochrane Collaboration Effective Practice and Organization of Care (EPOC) Group and the Groupe de Recherche en Gestion Thérapeutique, University of Montreal, an internationally recognized research and development DM team.B) to examine how DM could be tailored to the Swiss healthcare system using quantitative and qualitative methods surveying the opinion of selected stakeholders in Switzerland (patients, physicians, nurses, insurers, politicians, administrators), and to identify barriers and facilitators to its broad-scale implementation;C) to evaluate the effectiveness of two Swiss DM programs, the «Diabaide Disease Management Program» and the «Early Psychosis Prevention and Intervention». Whenever possible, control groups will be set up, and the effect of the intervention will be analyzed according to disease severity, adjusting for baseline differences across groups;D) to develop and conduct a pilot study of a pragmatic 3-arm randomized controlled trial aiming at comparing usual care to a “light” and “heavy” chronic obstructive pulmonary disease (COPD) DM program. The intervention will be based on a program developed at McGill University by J Bourbeau ("Living well with COPD”) and the two arms will use incremental combinations of DM elements.I will also ensure a personal professional development via training, conferences, sojourns in centers of excellence, and participation to international collaborative projects. In addition, I will contribute to the development of, and provide expertise in the field of DM for chronic diseases in Switzerland.DM is a major and innovative response to the development of health care for chronic conditions. It has to be backed by a substantial effort in health services research, and calls for high quality research and development in Switzerland. The proposed research projects will definitely contribute to the development of DM to tackle the health and cost burden due to chronic conditions in Switzerland.
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Effectiveness of interventions targeting frequent users of emergency departments: a systematic review.
Althaus Fabrice, Paroz Sophie, Hugli Olivier, Ghali William A, Daeppen Jean-Bernard, Peytremann-Bridevaux Isabelle, Bodenmann Patrick (2011), Effectiveness of interventions targeting frequent users of emergency departments: a systematic review., in Annals of emergency medicine, 58(1), 41-41.
Freedom of choice of specialist physicians is important to Swiss resident: A cross-sectional study.
Peytremann-Bridevaux I, Ruffieux C, Burnand B (2011), Freedom of choice of specialist physicians is important to Swiss resident: A cross-sectional study., in Swiss medical weekly, 141, 13315-13315.
Integrated care organizations in Switzerland.
Berchtold Peter, Peytremann-Bridevaux Isabelle (2011), Integrated care organizations in Switzerland., in International journal of integrated care, 11 Spec Ed, 010-010.
Disease management: a proposal for a new definition.
Peytremann-Bridevaux Isabelle, Burnand Bernard (2009), Disease management: a proposal for a new definition., in International journal of integrated care, 9, 16-16.
Inventory and perspectives of chronic disease management programs in Switzerland: an exploratory survey.
Peytremann-Bridevaux Isabelle, Burnand Bernard (2009), Inventory and perspectives of chronic disease management programs in Switzerland: an exploratory survey., in International journal of integrated care, 9, 93-93.

Associated projects

Number Title Start Funding scheme
139789 Disease management: effectiveness and implementation 01.01.2012 Ambizione

Abstract

Worldwide, cardiovascular diseases, chronic lung diseases, diabetes, cancer and depressive disorders constitute a major burden for communities in terms of morbidity, disability and mortality. This burden is expected to grow with aging and increase in longevity. In addition, patients’ expectations toward healthcare are growing, and technological innovations provide new diagnostic and treatment possibilities, which increase the complexity and costs of health care. Although most care in developed countries is delivered for chronic conditions, health care systems are still mainly directed towards acute care. Furthermore, tensions occur in a context characterized by a likely future shortage in the healthcare workforce. Therefore, healthcare systems face a formidable challenge to manage chronic conditions appropriately. To address these problems, chronic disease management (DM) strategies have been developed. They are a means of reorganizing healthcare systems and medical treatment for chronic diseases. DM programs are centered on patient's needs, based on formal evidence of effectiveness, foster the coordination and the integration of health services provided by various professionals, promote the self-management by the patient and, more generally, aim at improving communication between patients and healthcare providers. Importantly, DM could contribute to improve knowledge transfer in real practice. In Switzerland, DM is in its infancy, and programs are rather scarce.Systematic reviews suggest that for diseases such as diabetes, heart failure, chronic lung diseases and depression, DM programs are effective in terms of processes and outcomes of care (e.g. improvements of diabetic patients’ glycemic control; decreased probability of hospitalization for heart failure patients). However, results of cost-effectiveness evaluations or costs studies do not always show benefits. A wider implementation of DM programs is appealing, but several questions need further investigation before generalizing these programs. While components of DM programs can improve quality of care of chronic diseases, it remains unclear how far each component is essential, and which combination of elements brings the greatest benefit to patients. Also, main weaknesses of previous studies include the short follow-up periods, the low power to detect significant effects of DM on clinically relevant outcomes, and the heterogeneity of both interventions under study and patients included. Additionally, several other issues remain unanswered, e.g., How to best handle complexity due to the coexistence of more than one chronic conditions? - What is the acceptance of such programs, and how to overcome barriers to change?The 3-year research proposal includes the following 4 projects:A) to conduct two systematic literature reviews to assess (i) the effectiveness of DM for asthma, and (ii) the specific role of, and effectiveness of teamwork in DM, across diseases. This will be done, respectively, in collaboration with the Cochrane Collaboration Effective Practice and Organization of Care (EPOC) Group and the Groupe de Recherche en Gestion Thérapeutique, University of Montreal, an internationally recognized research and development DM team.B) to examine how DM could be tailored to the Swiss healthcare system using quantitative and qualitative methods surveying the opinion of selected stakeholders in Switzerland (patients, physicians, nurses, insurers, politicians, administrators), and to identify barriers and facilitators to its broad-scale implementation;C) to evaluate the effectiveness of two Swiss DM programs, the «Diabaide Disease Management Program» and the «Early Psychosis Prevention and Intervention». Whenever possible, control groups will be set up, and the effect of the intervention will be analyzed according to disease severity, adjusting for baseline differences across groups;D) to develop and conduct a pilot study of a pragmatic 3-arm randomized controlled trial aiming at comparing usual care to a “light” and “heavy” chronic obstructive pulmonary disease (COPD) DM program. The intervention will be based on a program developed at McGill University by J Bourbeau ("Living well with COPD”) and the two arms will use incremental combinations of DM elements.I will also ensure a personal professional development via training, conferences, sojourns in centers of excellence, and participation to international collaborative projects. In addition, I will contribute to the development of, and provide expertise in the field of DM for chronic diseases in Switzerland.DM is a major and innovative response to the development of health care for chronic conditions. It has to be backed by a substantial effort in health services research, and calls for high quality research and development in Switzerland. The proposed research projects will definitely contribute to the development of DM to tackle the health and cost burden due to chronic conditions in Switzerland.
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