A national program on “disease management of chronic diseases” provided funding for practices planning a redesigning of care based on the CCM. Requirements of the national program were that the practices had to have some experience with the delivery of chronic care and were equipped to implement systems needed for the delivery of high quality chronic care. This resulted in the inclusion of 22 DMPs (out of 38). These DMPs can be considered to be among the leaders of chronic care DAPT delivery in the Netherlands. Patients enrolled in these practices receive high quality care. It was not possible to recruit proper control patients from the

same practices because implementing a DMP requires redesigning

the care delivery structure, which affects all patients in a practice. Also we were not able to find control or comparison groups for all chronic diseases in other regions. This study included patients participating in 18/22 DMPs based on the CCM that were implemented in various Dutch regions. Four DMPs were excluded due to (1) a small sample (<15 patients), (2) delayed questionnaire distribution resulting in incomplete data, (3) inclusion of hospitalized patients rather than community-based primary care patients, and (4) slightly different questionnaire content to address a specific mental health condition. The 18 DMPs were CAL-101 in vitro characterized as collaborations between care sectors (e.g., between general practitioners and hospitals) or within primary care settings (e.g., among pharmacists, physiotherapists, dieticians, social workers),

and by the population targeted: patients with cardiovascular diseases (n = 9), chronic obstructive pulmonary disease (n = 4), heart failure (n = 1), comorbidity (n = 1), and diabetes (n = 3). See the appendix for a detailed overview Astemizole of the interventions implemented in each DMP. In 2010 (T0), most DMPs had finished developing interventions based on the CCM [e.g., information and communication technology (ICT) systems, training of professionals, care protocols, redistribution of tasks] and had started to enroll patients. The CCM incorporates flexibility in the implementation of interventions; thus, all DMPs incorporated the elements of the CCM in varying contexts and to various extents. The most common interventions aiming specifically to improve the health behavior of DMP participants were: the use of individual care plans with personal goals, tailored interventions for smoking cessation and the improvement of physical activity, patient education, patient training in active participation and self-management, the use of personal coaches/counselors, and the facilitation of self-monitoring. This study was approved by the Ethics Committee of Erasmus University Medical Center, Rotterdam (September 2009).