Implementation of Disease Management Programs for Chronic Care – Structuring Complexity through Chains of Interpretion and Conflicting Pressures

Vrangbaek, Karsten; Vrangbaek, Karsten

Chronic diseases such as Diabetes and COPD are major causes of death and reduction in quality of life worldwide, and their prevalence is expected to rise due to changing demographics. Disease management programs (DMPs) have been presented as a policy response to challenges of care coordination for chronic diseases. While their design differs, they share a common aspiration of developing and formalizing processes to support patient journeys and facilitate collaboration in the management of chronic conditions (Schang et al.2016, Tsiachristas et al. 2013). To achieve this, DMPs rely on detailed descriptions of the sequence of diagnostic, treatment and rehabilitation procedures and specifications of which health and social care actors that are to deliver services at different points in time.

DMPs are supposed to reduce duplication and redundancies in services and to improve patient experiences and health outcomes. Supplementary objectives are to improve efficiency by reducing the resources needed to deal with chronic care patients. Achieving these results depends on the implementation of the program. It is therefore highly relevant to evaluate implementation processes and the ensuing design decisions (Schang et al. 2016).

This paper investigates the design and implementation of DMPs in a National Health Care system in the Nordic region using diabetes as the main empirical focus. By doing so, we can extend previous analyses of DMP implementation in continental European SHI type systems Germany and Austria (Schang et al. 2016) and internationally (Nolte et al. 2008 and 2012) with an additional case from a public integrated HC system.

Association for Public Policy Analysis & Management

Panel Paper: Implementation of Disease Management Programs for Chronic Care – Structuring Complexity through Chains of Interpretion and Conflicting Pressures

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