DISMEVAL Developing and Validating Disease Management Evaluation Methods for European Healthcare Systems Final Report
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DISMEVAL Developing and validating disease management evaluation methods for European healthcare systems Final report Edited by Ellen Nolte and Saba Hinrichs, on behalf of the DISMEVAL Consortium Prepared for the European Commission on behalf of the DISMEVAL Consortium EUROPE The reseach described in this document was prepared for the European Commission on behalf of the DISMEVAL Consortium. RAND Europe is an independent, not-for-profit research organisation whose mission is to improve policy and decision making for the public good. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark. © Copyright 2012 RAND Corporation and DISMEVAL Consortium All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the clients. Published 2012 by the RAND Corporation 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665 Westbrook Centre, Milton Road, Cambridge CB4 1YG, United Kingdom RAND URL: http://www.rand.org RAND Europe URL: http://www.rand.org/randeurope To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] Preface This report is the fifth formal deliverable (D5) to the European Commission of the DISMEVAL project (grant agreement 223277). DISMEVAL is a European collaborative project with the overarching aim to contribute to developing new research methods and to generating the evidence base to inform decisionmaking in the field of chronic disease management evaluation. We here report on the overall findings of the work carried out within the DISMEVAL project, documenting background, methods, results and discussion for each of the work packages WP2 to WP10. The project has identified and tested a wide range of methods that can be employed in situations where experimental approaches are not possible, emphasising that rigorous evaluation is still possible even where baseline or predefined control groups are not available and how advanced designs can help better understand how different (combinations of) care components and processes might be effective for managing chronic disease in patients with different characteristics. Future evaluation work drawing on such approaches can provide insight into what works for whom in the area of disease management, a question that randomised trials have thus far been unable to answer. RAND Europe is an independent not-for-profit policy research organisation that aims to improve policy and decisionmaking in the public interest, through research and analysis. RAND Europe’s clients include European governments, institutions, NGOs and firms with a need for rigorous, independent, multidisciplinary analysis. This report has been peer-reviewed in accordance with RAND’s quality assurance standards. For more information about RAND Europe or this report, please contact: Dr. Ellen Nolte Director, Health and Healthcare RAND Europe Westbrook Centre, Milton Road Cambridge CB4 1YG United Kingdom Email: [email protected] Tel: +44 (0)1223 273853 iii Contents Preface ........................................................................................................................ iii Contents ....................................................................................................................... v List of Figures .............................................................................................................. ix List of Tables ............................................................................................................... xi Summary ...................................................................................................................xiii DISMEVAL Consortium .......................................................................................... xix Acknowledgements .................................................................................................... xxi CHAPTER 1 Introduction ........................................................................................... 1 1.1 Context ............................................................................................................. 1 1.2 The DISMEVAL project ................................................................................... 2 1.3 Conceptualising chronic disease and chronic disease management ..................... 4 1.4 Structure of this report ...................................................................................... 5 CHAPTER 2 Approaches to chronic disease management in Europe ........................... 7 2.1 Introduction ...................................................................................................... 7 2.2 Methods ............................................................................................................ 7 2.3 Findings .......................................................................................................... 11 2.4 Summary ......................................................................................................... 23 CHAPTER 3 Assessment of existing approaches to evaluate disease management in Europe .............................................................................................. 25 3.1 Introduction .................................................................................................... 25 3.2 Methods .......................................................................................................... 25 3.3 Findings .......................................................................................................... 27 3.4 Summary ......................................................................................................... 33 CHAPTER 4 Assessing the policy context for chronic disease management in Europe .................................................................................................. 35 4.1 Introduction .................................................................................................... 35 4.2 Methods .......................................................................................................... 37 4.3 Findings .......................................................................................................... 38 4.4 Summary ......................................................................................................... 44 CHAPTER 5 Evaluation of disease management in Austria ....................................... 47 v DISMEVAL RAND Europe 5.1 Introduction .................................................................................................... 47 5.2 Disease management intervention that formed the basis for testing and validating evaluation methods and metrics in Austria ....................................... 49 5.3 Methods .......................................................................................................... 49 5.4 Findings .......................................................................................................... 52 5.5 Discussion ....................................................................................................... 56 CHAPTER 6 Evaluation of disease management in Denmark .................................... 59 6.1 Introduction .................................................................................................... 59 6.2 Disease management