Disease Management Program Breast Cancer – First Experience

In the 1990s, Disease Management Programs (DMPs) were developed in the USA as proactive approaches and integrated, continuing care concepts based on guidelines and recommendations and including the points of view of both patients and care providers. The aim was to improve outcome and reduce costs whilst taking into consideration patient risk profiles. Early experiences gained in Germany are reported. Materials and Methods: The methods used to implement reliable medical and health-political framework conditions for patients with breast cancer on the basis of the best possible current treatment standards is depicted using the Baden-Württemberg treatment program. Results: Of the 130 hospitals in Baden-Württemberg, 41 hospitals and 4 university clinics fulfil the DMP quality criteria. To date, 98 hospital physicians have been licensed as DMP physicians for primary therapy, and in out-patient care, 1,380 DMP physicians have qualified. 44% of the 973 partaking gynecologists, 57% of the 272 general practitioners and 22% of the 131 internists have registered active patients so far. Conclusions: At the moment, the quality of results is not covering all factors, because the necessary structural quality has not yet been achieved. Previous experience shows that advantages have been obtained in the sectors of psychosocial care and structured treatment, but that there are still problems. These are found particularly in the flow of data and bureaucracy with the result that physicians have compliance problems. The target must be to eliminate existing weaknesses, for instance in providing the links missing between DMP, quality assurance, breast centers, cancer registers and screening programs. This would, in turn, achieve future feedback for the care providers so that they are fully informed on the quality of results.