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Disease management programmes (DMPs) provide structured treatment aimed at improving the quality of therapy and health care. Since the beginning of the DMP contracts for type 1 diabetes in 2005 (Westphalia-Lippe) and 2006 (North Rhine), various care targets have been reported on a recurring basis as an instrument of quality assurance. The quality criteria are based on the care guidelines and are regularly reviewed and adjusted. On the one hand, the rates of target achievement for all DMP participants are compiled nationwide by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV). On the other hand, the Evaluation and Quality Assurance Department of the Central Institute for Statutory Health Insurance (Zentralinstitut für die kassenärztliche Versorgung, ZI) provides detailed data broken down by sex and age group for NRW in the DMP Atlas North Rhine-Westphalia. Data from NRW for the years 2013 to 2022 is presented below and selected results are classified epidemiologically. Further results are contained in the two DMP quality reports 2022 for North Rhine and Westphalia-Lippe.
The proportion of DMP participants for whom severe hypoglycaemia could be avoided increased from 95.1% in 2013 to 98.3% in 2022. This significantly exceeded the contractually required minimum percentage of 85%. Similarly, emergency inpatient treatment was avoided in 99.4% of those treated in 2022, thus the required target of 98% was also exceeded.
Between 2013 and 2022, the proportion of those who achieved their individually agreed HbA1c targets increased from 38.7% to 46.9%, indicating that more than half of those receiving care in the DMP type 1 diabetes still did not achieve their individual targets in 2022. Only those over 60 and under 10 years of age had a rate of over 50%.
In 2022, 70.9% of those under 30 years of age receiving care in NRW achieved the new target (HbA1c maximum 8.5%), while the proportion of those under 11 years of age receiving care was 86.6%. The contractual requirement here is 80 %. In the group of care recipients aged 30 and over, for whom a 90% achievement rate is required, a total of 80.9% achieved the target. For the blood pressure target below 140/90 mmHg, the rate fell from 60.7% in 2013 to 53.3 % in 2022, indicating that the required proportion of 60% was not achieved in 2022.
With regard to those quality targets that relate to regular checks in the DMP type 1 diabetes, the rates achieved decreased for all indicators between 2013 and 2022, even if the checks were carried out for a high proportion of those receiving DMP care. The rate for checking kidney function fell from 79.1% to 76.5%, for checking urine albumin from 81.4% to 70.2%, for checking foot status from 91.6% to 83.8% and for checking injection sites from 92.6% to 80.9%. The required rates of 90% for these indicators were thus not achieved in 2022, with the exception of foot status checks, for which the required minimum percentage is 80%. It should be noted that there are hardly any sex differences in any of the above indicators.
For the year 2022, an indicator on patient training attendance was evaluated for the first time in the DMP Atlas. The indicator shows the proportion of people in a DMP for type 1 diabetes who take part in training within one year after a training recommendation. For these people, a rate of 88.6% and 92.9% was achieved in NRW for diabetes and hypertension training, respectively.
There are currently no contractually defined minimum rates for the targets for attending diabetes and hypertension training in the DMP type 1 diabetes; this also applies to the proportion of those who achieve their individually agreed HbA1c target value. Of the ten quality objectives with quantitative targets, only three were achieved in 2022.
For the DMP type 1 diabetes in Germany, no studies are known to date that measure the influence of DMP participation on health outcomes and evaluate it in comparison to non-participation. However, an international study shows that the DMP concept leads to improved blood glucose control in type 1 diabetes (Lin et al. 2016). As the quality targets of the DMP also reflect the content of therapy guidelines, evidence-based therapy can be assumed if the targets are implemented. Although low HbA1c values in type 1 diabetes are also associated with risks such as the occurrence of hypoglycaemia, the frequency of hypoglycaemia in participants also decreases over time and is at a low level.