Case management for multimorbid patients

1. Case management for multimorbid patients Nathalie Versnel, MSc. François Schellevis, MD, PhD Giel Nijpels, MD, PhD Caroline Baan, PhD

2. Background • Co-morbid T2DM patients • Participating in several disease specific management programs could lead to uncoordinated care. • Case management in addition to disease management DM Diabetes Care CM All other chronic conditions 1

3. Background • Results literature review – Lower health care costs, – Higher patients‘ perceived quality of care, – Higher satisfaction of patients and caregivers • http://dx.doi.org/10.1016/j.healthpol.2012.06.006 2

4. Aim To investigate the effects of a case management program on quality of care for co-morbid T2DM patients. 3

5. Methods – study design • RCT - 2 Practice Nurses (PN) - 230 patients - 8 practices - 12 months • Intervention group (n=115) case management additional to centrally organized managed care (diabetes care) • Control group (n=115) Only centrally organized managed care 4

6. Methods – population • Co-morbid T2DM patients • Participate in the Diabetes Care System • Included comorbid diseases - cancer - chronic ischemic heart disease - chronic obstructive pulmonary disease (COPD) - Depression - osteoarthritis of hip and/or knee - rheumatoid arthritis - stroke 5

7. Methods - intervention • Elements of the case management program - assessing health care needs by Resident Assessment Instrument (RAI) - discussing care plan with the diabetes patient - monthly monitoring - multidisciplinary meetings if needed - coordination of care 6

8. Methods - data collection • Quantitative - Review of the patients’ medical record at the GP. - Postal patient questionnaires at baseline, at 3 and at 12 months. - RAI assessment at baseline and at 12 months. • Qualitative - Semi-structured in-depth interviews for insight in factors favoring and hampering implementation of the program. 7

9. Outcome measures • Primary; difference between the intervention and the control group, after 12 months in the quality of care as perceived by the patients (CQ-Index for GP care and PACIC) • Secondary; - quality of care from the professional perspective (quality indicators) - health status (change in score on the SF-12) - diabetes control (Hba1c) - health care utilization (medication use; number of contacts with care providers) 8

10. Situation at present • First patient started February 2011, last patient July 2012 • 199 patients • 10 trained PN's • 11 Primary Care Practices 9

11. Baseline characteristics (n=173) 10

12. Conclusion • Results will be available in 2014 • Website study review; http://dx.doi.org/10.1016/j.healthpol.2012.06.006 11