Disease-Management Programs Can Improve Quality of Care for the Chronically Ill, Even in a Weak Primary Care System: A Case Study from Germany

Enhancing the coordination and quality of care for chronically ill patients is a challenge across health care systems. In Germany, following a 2002 reform, physician-based and patient-centered disease-management programs (DMPs) were implemented in a nationwide rollout. These programs are characterized by information technology support, the central role of a designated doctor in ambulatory care, a patient-centered approach that encourages patient self-management, quality assurance (including reminders and benchmarking), and financial incentives for physicians, patients, and sickness funds. Results of a four-year follow-up show that despite the programs’ implementation in a weak primary care system, quality of care and patient satisfaction have improved while hospitalization rates, duration of hospital stay, patient mortality, and drug costs have been significantly lowered. In some areas up to 90 percent of all eligible patients are enrolled, thereby giving the programs a broadly representative base.