Implementing a disease management program in Swiss primary care to improve diabetes care : results and experiences from a long-term follow-up study

Background & Aim : This study assesses the long-term impact of a Disease Management Program (DMP) on the quality and costs of diabetes care with a five-year follow-up. Implemented across 16 group practices from 2018 to 2022, the DMP included a guideline-based, individualized treatment plan for diabetes patients, continuous process evaluation, interprofessional collaboration, quality circles, and scientific support. Our aim is to evaluate the efficacy and effectiveness of the DMP and provide evidence on its implementation, with timely feedback enabling healthcare providers to address areas for improvement. Methods : We used a staggered difference-in-difference (DiD) design to analyze claims data from adults with type 1 and type 2 diabetes. Participants included 3,302 individuals in DMP practices and 20,104 in usual care. Primary outcomes were guideline adherence, hospitalization rate, and healthcare costs. The staggered DiD approach assessed the DMP's impact across different practices and periods while controlling for patient- and year-fixed effects. Results : DMP patients showed a 6 percentage-point improvement in guideline adherence [95%-CI: 4 to 9 percentage-points] compared to controls, maintained over five years. Hospitalization rates were similar in both groups. Healthcare costs increased more slowly in the DMP group, with significant differences in the fourth [95%-CI: CHF -2,056 to -566] and fifth [95%-CI: CHF -2,983 to -1,435] years post-implementation, indicating potential long-term cost savings. Discussion & Conclusion : The DMP had a sustained positive impact on guideline-adherence and healthcare costs. The staggered DiD design provides robust evidence across various settings and periods. Strengths include a large sample size and real-world data; limitations include its observational nature. Our findings underscore the importance of DMPs in chronic disease management, highlighting the benefits of collaboration with healthcare providers. We address challenges in implementing and evaluating quality improvement processes, such as data quality, resource limitations, and insufficient digitalization.