Collective Was not Representative
; ; ; ;
Linder et al compared TK insurance members who were registered in the T2DM with those who were not. Because of similar findings in both groups they conclude that the T2DM is not effective, inefficient, and does not make sense in its current form. This cannot be deduced from what they described in their article. Critiquing individual methodological details would take up too much space here. Other types of sickness funds reached reverse conclusions using comparable methods (Stock et al, 2010).
Linder et al criticized that the DMP quality report of the statutory health insurance in North-Rhine did not evaluate the programs appropriately. On the basis of this report, however, it is possible to show in a transparent and detailed fashion the extent to which those registered with the DMP in the region actually reached the objectives set for them. The analogous criticism of the ELSID study is not justified because ELSID is currently the methodologically most complex, prospective, control group-based study of the medical effectiveness, health related costs, and quality of life in patients with type 2 diabetes in Germany.
Whether the TK study is representative for the entire collective of patients with type 2 diabetes seems questionable on the basis of the experiences gathered in North-Rhine. According to these, TK insurance members are younger than the average of all participants registered in the T2DM and mainly male; during their participation in the T2DM they developed fewer complications and continually showed better metabolic and blood pressure control than all other registered diabetes patients.
In order to make robust, generalizable statements, it would therefore be necessary to:
- Match TK insurance members with non-TK insurance members regarding their specific characteristics and baseline status,
- Extend the observation period beyond the study timeframe (here, a maximum of two years was considered), and
- Document numerically the frequency of individual end points, as well as outpatient and inpatient costs in additional tables.
Dr. rer. soc. Lutz Altenhofen
Dr. phil. Bernd Hagen
Dipl. Psych. Jens Kretschmann
Dr. rer. nat. Sabine Groos
Zentralinstitut für die kassenärztliche Versorgung
in der Bundesrepublik Deutschland
DMP Projektbüro (ZI), Köln
Dr. rer. pol. Dominik Graf von Stillfried
Zentralinstitut für die kassenärztliche Versorgung, Berlin
Conflict of interest statement
The DMP project office undertakes certain tasks for the purposes of quality assurance for the DMP in North Rhine-Westphalia, on behalf of the Association of Statutory Health Insurance Physicians in North Rhine-Westphalia and the association of hospitals (Krankenhausgesellschaft) NRW.
|1.||Stock S, Drabik A, Büscher G, et al.: German diabetes management programs improve quality of care and curb costs. Health Aff (Millwood); 2010; 29: 2197–205. CrossRef MEDLINE|
|2.||Linder R, Ahrens S, Köppel D, Heilmann T, Verheyen F: The benefit and efficiency of the disease management program for type 2 diabetes. Dtsch Arztebl Int 2011; 108(10): 155–62. VOLLTEXT|