Table 1.

Overview of Interventions Implemented within 18 Disease Management Programs in The Netherlands.

CCM Dimension	Intervention	Number of Programs	%
Health care organization	Integrated financing of disease management	9	50
	Specific policies and subsidies for immigrant population	5	28
	Sustainable DMP financing agreements with health insurers	10	56
Community	Communication platform between stakeholders about patients	2	11
	Health market	1	6
	Cooperation with external community partners	15	83
	Multidisciplinary and transmural collaboration	14	78
	Role model in the area	8	44
	Regional collaboration for DMP expansion	8	44
	Treatment and care pathways in outpatient and inpatient care	15	83
	Involvement of patient groups and panels in care design	9	50
	Regional training course	13	72
	Family participation	3	17
Self-Management	Promotion of disease-specific information	14	78
	Individual care plan	13	72
	Lifestyle interventions (eg, physical activity, diet, smoking)	16	89
	Support of self-management (eg, Internet, e-mail, SMS)	2	11
	Telemonitoring	0	0
	Personal coaching	15	83
	Motivational interviewing	16	89
	Informational meetings	6	33
	Diagnosis and treatment of mental health issues	7	39
	Reflection interviews	0	0
	Group sessions for patient and family	5	28
	Cognitive behavioral therapy	1	6
Decision Support	Care standards/clinical guidelines	18	100
	Uniform treatment protocol in outpatient and inpatient care	10	56
	Training and independence of practice assistants	18	100
	Professional education and training for care providers	18	100
	Automatic measurement of process/outcome indicators	16	89
	Use of care protocols for immigrants	1	6
	Audit and feedback	10	56
	Periodic evaluation of interventions and goal achievement	6	33
	Structural participation in knowledge exchange/best practices	11	61
	Quality of life questionnaire	7	39
	Evaluation of health care via focus groups with patients	4	22
	Measurement of patient satisfaction	9	50
Delivery System Design	Delegation of care from specialist to nurse/care practitioner	16	89
	Substitution of inpatient with outpatient care	11	61
	Systematic follow-up of patients	16	89
	One-stop outpatient clinic	3	17
	Specific plan for immigrant population	3	17
	Expansion of chain of care to the secondary care setting	6	33
	Joint consultation hours	3	17
	Meetings of different disciplines to exchange information	17	94
	Monitoring of high-risk patients	13	72
	Board of clients	4	22
	Periodic discussions between care professionals (and patients)	11	61
	Stepped care method	6	33
Clinical Information Systems	Electronic patient records system with patient portal	1	6
	Hospital or practice information system	18	100
	Integrated Chain information system	10	56
	Use of ICT for internal and/or regional benchmarking	14	78
	Creation of a safe environment for data exchange	8	44
	Systematic registration by every caregiver	15	83
	Exchange of information among care disciplines	12	67

CCM, chronic care model; DMP, disease management program; SMS, short message service; ICT, information and communication technologies.