Management of Chronic Diseases

« back to ‘Projects’ page


Disease management programmes have been developed to stem the further increase in chronic diseases, prevent or as far as possible postpone complications and comorbidity and promote the patient’s quality of life and control over his or her personal health. There is some evidence to support the effectiveness of disease management, but many questions still remain. The Organisation for Health Research and Development (ZonMw) has therefore developed a programme aimed at initiating local and regional experiments in disease management and promoting the application of knowledge and insights from successful projects in health care in practice. To determine which interventions are the most suitable for improving the quality of care, the ‘black box’ of disease management programmes must be opened. An assessment study that focuses on outcomes, processes, costs and their interrelationship is essential in this effort.

Project leader and secretary:

Assessment study

The goal of this study is to assess different disease management projects. By describing the projects using the same theoretical framework and a similar structure, process and outcome benchmarks, it is possible to make a solid comparison between different projects.

The leading research questions are:

  1. Is it possible to (further) develop a general framework and to apply it to the components of different disease management programmes and different patient populations?
  2. What are the effects of disease management interventions on the primary outcomes at the patient, professional and organisational level?
  3. Which interventions are actually carried out in the context of the ‘management of chronic diseases’ programme?
  4. What are the total costs (including the implementation costs and all derived care costs) that accompany the interventions and how are they funded and reimbursed?
  5. How do these costs relate to the effects described in question 2?
  6. What are crucial success and failure factors that impact the effectiveness of disease management interventions, and how is this knowledge spread to other settings?

In this study, these questions are answered by means of a ‘mixed methods’ design, i.e. a combination of qualitative and quantitative research methods. The quantitative study employs, if possible, a cluster-randomised design to determine the effect of disease management programmes on care processes and outcomes. The clusters consist of care clinics, regions, hospitals, etc. Using questionnaires completed by patients, carers and professionals, data is collected on process, intermediary and outcome indicators. Where possible, existing databases are also used. The qualitative data is collected in order to produce a comprehensive description of both the interventions and the context in which the projects take place. A cost-effectiveness analysis will also be performed.



  • Netherlands Organisation for Health Research and Development (ZonMw)


  • Vilans
  • Picasso
  • 22 field projects
  • Education/research: Institute of Health Policy & Research (Erasmus University), Rotterdam University of Applied Sciences - Institute for Health, Erasmus MC


Articles published/in press

1. Cramm, J.M., Nieboer, A.P. (2012). In The Netherlands, Rich Interaction Among Professionals Conducting Disease Management Led To Better Chronic Care. Health Affairs. Doi: 10.1377/hlthaff.2011.1304.

2. Cramm, J.M., Nieboer, A.P. (2012). Factorial validation of the Patient Assessment of Chronic Illness Care (PACIC) and PACIC short version (PACIC-S) among cardiovascular disease patients in the Netherlands. Health and Quality of Life Outcomes, 10:104.

3. Cramm, J.M., Nieboer, A.P. (2012). The Chronic Care Model: congruency and predictors among patients with cardiovascular diseases and Chronic Obstructive Pulmonary Disease in the Netherlands. BMC Health Services Research. 12:242.

4. Cramm, J.M., Rutten-Van Mölken, M.P.M.H., Nieboer, A.P. (2012). The potential for integrated care programmes to improve quality of care as assessed by patients with COPD: early results from a real-world implementation study in The Netherlands. International Journal of Integrated Care, 191.

5. Tsiachristas, A.,  Cramm, J.M., Nieboer, A.P. Rutten-Van Mölken, M.P.M.H. (2012). Broader economic evaluation of disease management using multi-criteria decision analysis. Forthcoming: International Journal of Technology Assessment in Health Care.

6. Hipple-Walters, B., Adams, S, Nieboer, A.P., Bal, R. Disease management projects and the Chronic Care Model in action: baseline qualitative research. BMC Health Services Research. 12:114

7. Cramm, J.M., Nieboer, A.P. (2012). Self-management abilities predict physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes. Patient Education and Counseling. doi: 10.1016/j.pec.2011.12.006.

8. Cramm, J.M., Strating, M.M.H., Vreede, P.L. de, Steverink, N., Nieboer, A.P. (2012). Validation of the Self-Management Ability Scale (SMAS) and development and validation of a shorter scale (SMAS-S) among older patients shortly after hospitalisation. Health and Quality of Life Outcomes. 10:9.

9. Cramm, J.M., Nieboer, A.P. (2012). Disease-management partnership functioning, synergy, and effectiveness in delivering chronic-illness care. International Journal for Quality in Health Care. doi: mzs004.

10. Cramm, J.M., Nieboer, A.P. (2012). Relational coordination promotes quality of chronic-care delivery in Dutch disease-management programs. Health Care Management Review. doi: 10.1097/HMR.0b013e3182355ea4.

11. Tsiachristas, A., Hipple-Walters, B., Lemmens, K.M.M., Nieboer, A.P., Rutten-Van Mölken, M.P.M.H. (2011). Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers. Health Policy. 101(2):122-132.

12. Cramm, J.M., Strating, M.M.H., Nieboer, A.P. (2011). Development and validation of a short version of the Partnership Self-Assessment Tool (PSAT) in Dutch disease management partnerships. BMC research notes. 4:224.

13. Cramm, J.M., Strating, M.M.H., Tsiachristas, A., Nieboer, A.P. (2011). Development and validation of the short version of the Assessment of Chronic Illness Care (ACIC) in Dutch disease management programs. Health and Quality of Life Outcomes. 9:49.

14. Lemmens, K.M.M., Rutten-Van Mölken, M.P.M.H., Cramm, J.M., Huijsman, R. Bal, R. Nieboer, A.P. (2011). Evaluation of a large scale implementation of disease management programmes in various Dutch regions: a study protocol. BMC Health Services research. 11:6.

Submitted articles

15. Cramm, J.M., Nieboer, A.P. Short and long term improvements in quality of chronic care delivery predict program sustainability. Submitted: Milbank Quarterly.

16. Cramm, J.M., Tsiachristas, A., Hipple-Walters, B., Adams, S., Bal, R., Huijsman, R ., Rutten-Van Mölken, M.P.M.H., Nieboer, A.P. Cardiovascular disease management programmes as integrated care pathways: who is included and what does it take to develop and implement them? Submitted: International Journal of Integrated Care.

17. Cramm, J.M., Nieboer, A.P. The effects of social and physical functioning and self-management abilities on well-being among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes. Submitted: Applied Research in Quality of Life.

18. Cramm, J.M., Nieboer, A.P. High-Quality Chronic Care Delivery Improves Experiences of Chronically Ill Patients Receiving Care: Experiences from Patients with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease, Stroke, Eating Disorders, Heart Failure, and Comorbidity. Submitted: International Journal for Quality in Health Care.

19. Tsiachristas, A., Rutten-Van Mölken, M.P.M.H. Hierarchical modelling of patient’s costs in disease management programs for cardiovascular risk, diabetes and COPD. Submitted: Health Economics.

20. Hipple Walters, B., Adams, S., & Bal, R. In ‘control’ and Proud of it: Control themes in online eating disorder narratives. Submitted to Eating Disorders. Submitted: The Journal of Treatment and Prevention.

21. Tsiachristas A., Dikkers C., Boland M., Rutten-van Mölken M. System-wide impact of chronic care payment schemes in Europe: evidence from an empirical analysis. Submitted.

22. Dikkers C., Tsiachristas A., Boland M., Rutten-van Mölken M. Exploring payment schemes used to promote integrated chronic care in Europe. Submitted.

23. Boland M.R.S., Tsiachristas A., Kruis A.L., Chavannes N.C., Rutten-van Mölken M. Cost-effectiveness of disease management interventions for COPD: reviewing methods and evidence. Submitted.

Other publications

24. Tussenrapportage Praktijkprojecten Vitale Vaten: Jane Murray Cramm, Apostolos Tsiachristas, Bethany Walters-Hipple, Samantha Adams, Roland Bal, Robbert Huijsman, Maureen Rutten-Van Mölken and Anna Petra Nieboer. Evaluating cardiovascular disease management programmes
Preliminary results. 2011.