G.G. van Merode

Adoption of disease management model for diabetes in region of Maastricht

Chronic diseases and associated conditions will always pose a challenge to healthcare systems. New healthcare models are being introduced in Western countries in response to a set of problems that are evident to some degree in all health services—for example, uncoordinated arrangements for delivering care, bias towards acute treatment, neglect of preventive care, and inappropriate treatment.1 These models take account of the pressure on quality and costs of chronic care and originate from the overlapping approaches of integrated care (United States) and shared care (western Europe). 2 3 In the Netherlands, shared care models have acted as a precursor of the recently introduced concept of disease management. Although several disease management initiatives are emerging, the model is not being adopted as fast as might be expected from the benefits that are claimed to result from it.4 In this article we describe the process of moving from a shared care model to a disease management model by considering recent developments in diabetes care in the region of Maastricht. We also describe the use of health technology assessment to evaluate the model. #### Summary points The concepts of integrated care and shared care can be regarded, in the Netherlands at least, as the precursor of disease management Implementation of a shared care model for diabetes in the region of Maastricht ensured that necessary conditions were met for a disease management model Widespread use of disease management models is hampered by lack of evidence Evidence from health technology assessment is necessary to justify large scale use of disease management models but will not be sufficient by itself Shared care for patients with stable diabetes mellitus type 2 who were receiving care from an endocrinologist in an outpatient clinic was implemented in the region of Maastricht in 1997. Two changes were made from usual care: …

Simulation as decision tool for capacity planning

In this paper we demonstrate how discrete event simulation technique can be used to optimise the use of catheterization capacity. The patient flow at the catheterization room is described. A simulation model of the current situation was built in MedModel, a discrete event simulation package, and the model was validated. A short presentation of MedModel is given. To investigate alternative ways to optimise the use of the catheterization room three experiments were formulated, modelled and simulated. Two different scheduling strategies were applied to the current situation and the three experimental situations. The number of patients that can be treated and the duration of a working day were determined as measures of performance. The results of the simulation experiments are discussed. The results of these experiments give the management of the catheterization room valuable information how to optimise the use of the catheterization room.

A disease management programme for patients with diabetes mellitus is associated with improved quality of care within existing budgets

Aim  To assess the impact of a disease management programme for patients with diabetes mellitus (Type 1 and Type 2) on cost‐effectiveness, quality of life and patient self‐management. By organizing care in accordance with the principles of disease management, it is aimed to increase quality of care within existing budgets.

Advanced management facilities for clinical laboratories

As part of the OpenLabs (AIM 2028) programme a decision support system (DSS) for laboratory capacity management has been developed. This DSS contains a simulation module for determining the performance of planning rules given the equipment and staffing of the clinical laboratory and the demand for laboratory services. User requirements are discussed and a method is developed to (re-)define rules concerning various planning decisions. To show the functionality of the simulation module some simulation experiments are described.

Retinopathy and microalbuminuria in type 2 diabetes: determinants and time-dependency of the association

Background: The aim of this study was to identify the independent determinants of diabetic retinopathy (RET) and microalbuminuria (MA) and to assess the time-dependency of the association of RET with MA. Methods: In 668 out-patients with type 2 diabetes, RET was assessed by stereoscopic fundoscopy and by measuring the level of MA in untimed, triplicate urine collections on at least two and four separate visits, respectively, during a period of at least 24 months. RET was defined as RET of any type and MA as a urinary albumin-to-creatinine ratio (ACR) between 2 and 30 mg/mmol. Multiple logistic regression analysis was used to determine odds ratios (OR) and 95% confidence intervals (CI). The extent of the association (OR(assoc)) was estimated by the odds that a patient with RET has MA divided by the odds that a patient without RET has MA. Results: Common determinants of RET and MA were: systolic BP, HbA(1c), and triglycerides. Age, non-Caucasian ethnicity, and RET were associated with MA, whereas duration of diabetes and ACR were associated with RET. We estimated an overall OR(assoc) of 2.36 (95% CI, 1.72-3.24). The time-dependency of OR(assoc) showed a hyperbolically shaped curve, reaching a maximum value of 2.5 at 9.8 years after the diagnosis of type 2 diabetes. Conclusions: Our study, which supports what is currently known about independent determinants of diabetic RET and MA, suggests a drastic increase in clustering of RET and MA over the first 5 years before the diagnosis of type 2 diabetes.