Long-Term Effects of a Diabetes Disease Management Program on Quality of Care and Costs: A Staggered Difference-in-Differences Analysis

Long-Term Effects of a Diabetes Disease Management Program on Quality of Care and Costs: A Staggered Difference-in-Differences Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Long-Term Effects of a Diabetes Disease Management Program on Quality of Care and Costs: A Staggered Difference-in-Differences Analysis Marc Höglinger, Egger Thomas, Cornelia Caviglia, Maria Carlander, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7256353/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background & Aim : Evidence on long-term effectiveness of diabetes disease management programs (DMPs) remains limited, with mixed findings on sustainability and cost-effectiveness. This study evaluates the long-term impact of a comprehensive DMP on quality of care and healthcare costs over six years (2018–2023). The DMP was implemented in 17 Swiss primary care practices and featured guideline-based individualized treatment plans, continuous process evaluation, interprofessional collaboration, and quality circles. We assessed the program's impact on guideline-adherent diabetes care, hospitalization, and healthcare costs over six years (2018–2023). Methods : A staggered difference-in-differences (DiD) design analyzed claims data from 2,813 patients in 17 DMP practices (treatment group) and 17,906 patients receiving usual care (control group). Outcomes included guideline-adherent diabetes care (HbA₁c monitoring, lipid profiling, nephropathy assessment, ophthalmological examination), hospitalization, and healthcare costs. The staggered DiD approach accounted for variations in implementation timing and controlled for patient- and year-fixed effects. Results : Patients in DMP practices showed a sustained 6 to 11 percentage point improvement in guideline-adherent diabetes care (95% CI for the fifth follow-up year: 8 to 14 percentage points) compared to controls. Hospitalization rates did not differ significantly between groups (95% CI for the fifth year: -0.05 to 0.00). Healthcare cost growth was significantly lower in the DMP group in years three (95% CI: CHF -2353 to -879), four (95% CI: CHF -3023 to -1419), and five (95% CI: CHF -2942 to -796), representing average cost savings exceeding 10% of total healthcare costs per patient. Conclusion : The DMP led to sustained improvements in guideline-adherent diabetes care and reduced healthcare cost growth over six years. The staggered DiD design provides robust evidence across diverse settings and implementation timelines, addressing key gaps in long-term DMP effectiveness research. These findings support broader implementation of structured DMPs for improving quality and efficiency of diabetes care in primary care settings. JEL Classification: I10, I18 Diabetes DiseaseManagement Program Guideline-Adherence Cost-Effectiveness Ambulatory Care Quality of Care Difference-in-Differences Primary Care Healthcare Costs Chronic Care Management Claims Data Full Text Additional Declarations Competing interest reported. AR and CC are employed by Medbase, the healthcare organization that implemented the evaluated diabetes disease management program. BR, CF, MC, and MT are employed by SWICA, the health insurance company that funded this study and provided the claims data. MH and TE received research funding from SWICA for conducting this program evaluation. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 Apr, 2026 Reviews received at journal 04 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviews received at journal 29 Mar, 2026 Reviewers agreed at journal 29 Mar, 2026 Reviews received at journal 27 Mar, 2026 Reviewers agreed at journal 27 Mar, 2026 Reviewers agreed at journal 21 Mar, 2026 Reviews received at journal 27 Aug, 2025 Reviewers agreed at journal 25 Aug, 2025 Reviewers agreed at journal 21 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviewers invited by journal 19 Aug, 2025 Editor assigned by journal 11 Aug, 2025 Submission checks completed at journal 11 Aug, 2025 First submitted to journal 11 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7256353","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":505086626,"identity":"51c728b7-1e52-4570-a0ee-4bca23d4f561","order_by":0,"name":"Marc Höglinger","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYLACxgYgwQ4mGeQYJMBiB4jQwgzRYkyKFgg7sYGQFt32sw8/MO6wkZN3Zm57+KXiXvr82c3PJBhq7uDUYnYm3ViC8UyaseFhxnZjmTPFuY1zjplJMBx7hlvLgTQ2Bsa2w4kbmxnbpCXbEnKbJRLMbjA2HMat5fwzsJZ6iJZ/CelsEunf8Gu5AbElQZ6ZsU3yY0NCAo9EDgFbbjxjlkhsSzPcANQizXAswXCGRE75j4Rj+ByWxvjhY5uNvHx7+zPJHzUJ8vIz0jcbfKjBrQUMEoDY4AAwaniQRQgC+QZglP4gRuUoGAWjYBSMOAAAXvNVyxTLbYgAAAAASUVORK5CYII=","orcid":"","institution":"Zurich University of Applied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Marc","middleName":"","lastName":"Höglinger","suffix":""},{"id":505086627,"identity":"0c53b146-8cad-44c0-9fb5-891a68d7a9b6","order_by":1,"name":"Egger Thomas","email":"","orcid":"","institution":"Zurich University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Egger","middleName":"","lastName":"Thomas","suffix":""},{"id":505086628,"identity":"12ae1e55-ba02-42bd-a691-17cc486568a1","order_by":2,"name":"Cornelia Caviglia","email":"","orcid":"","institution":"Medbase Health Care Provider","correspondingAuthor":false,"prefix":"","firstName":"Cornelia","middleName":"","lastName":"Caviglia","suffix":""},{"id":505086632,"identity":"3c0d13f7-960a-479c-9adb-a43913ea0e98","order_by":3,"name":"Maria Carlander","email":"","orcid":"","institution":"SWICA Health Insurance","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Carlander","suffix":""},{"id":505086633,"identity":"9ecaeea7-60bf-4cd1-b98d-384f7c9131ff","order_by":4,"name":"Christian Frei","email":"","orcid":"","institution":"SWICA Health Insurance","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Frei","suffix":""},{"id":505086634,"identity":"6f43c57e-6fa6-4b96-975e-55942764e74e","order_by":5,"name":"Birgitta Rhomberg","email":"","orcid":"","institution":"SWICA Health Insurance","correspondingAuthor":false,"prefix":"","firstName":"Birgitta","middleName":"","lastName":"Rhomberg","suffix":""},{"id":505086635,"identity":"6734743e-d9e8-4c83-814d-5de9fad8da10","order_by":6,"name":"Adrian Rohrbasser","email":"","orcid":"","institution":"Medbase Health Care Provider","correspondingAuthor":false,"prefix":"","firstName":"Adrian","middleName":"","lastName":"Rohrbasser","suffix":""},{"id":505086636,"identity":"9d3da781-afd6-4adc-ada7-434d446d1fb3","order_by":7,"name":"Maria Trottmann","email":"","orcid":"","institution":"SWICA Health Insurance","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Trottmann","suffix":""}],"badges":[],"createdAt":"2025-07-30 21:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7256353/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7256353/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89980290,"identity":"cf4f3180-691c-43f9-bc00-2ca7a5e142a8","added_by":"auto","created_at":"2025-08-27 06:22:51","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":801351,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7256353/v1_covered_2dc6cfcb-ce50-4a39-a83d-901795bf9f44.pdf"}],"financialInterests":"Competing interest reported. AR and CC are employed by Medbase, the healthcare organization that implemented the evaluated diabetes disease management program. BR, CF, MC, and MT are employed by SWICA, the health insurance company that funded this study and provided the claims data. 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This study evaluates the long-term impact of a comprehensive DMP on quality of care and healthcare costs over six years (2018–2023). The DMP was implemented in 17 Swiss primary care practices and featured guideline-based individualized treatment plans, continuous process evaluation, interprofessional collaboration, and quality circles. We assessed the program's impact on guideline-adherent diabetes care, hospitalization, and healthcare costs over six years (2018–2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A staggered difference-in-differences (DiD) design analyzed claims data from 2,813 patients in 17 DMP practices (treatment group) and 17,906 patients receiving usual care (control group). Outcomes included guideline-adherent diabetes care (HbA₁c monitoring, lipid profiling, nephropathy assessment, ophthalmological examination), hospitalization, and healthcare costs. The staggered DiD approach accounted for variations in implementation timing and controlled for patient- and year-fixed effects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Patients in DMP practices showed a sustained 6 to 11 percentage point improvement in guideline-adherent diabetes care (95% CI for the fifth follow-up year: 8 to 14 percentage points) compared to controls. Hospitalization rates did not differ significantly between groups (95% CI for the fifth year: -0.05 to 0.00). 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These findings support broader implementation of structured DMPs for improving quality and efficiency of diabetes care in primary care settings.\u003c/p\u003e\n\u003cp\u003eJEL Classification: I10, I18\u003c/p\u003e","manuscriptTitle":"Long-Term Effects of a Diabetes Disease Management Program on Quality of Care and Costs: A Staggered Difference-in-Differences Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 06:14:44","doi":"10.21203/rs.3.rs-7256353/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-15T08:28:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-04T05:39:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193474363335899211015142327343528830406","date":"2026-04-01T09:24:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303932526769359421541320268288808817096","date":"2026-04-01T05:23:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T21:25:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121293620080627549006508144044355763066","date":"2026-03-29T20:24:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-27T10:36:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82315260060399182312059946699047160499","date":"2026-03-27T05:37:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56193506306810013325197732960111818976","date":"2026-03-21T20:10:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-27T13:53:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91782026219006233796380740213481364731","date":"2025-08-25T07:10:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257465974338736040594942746477173135464","date":"2025-08-21T12:11:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106773434195939849707484379087436390935","date":"2025-08-19T12:54:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-19T11:09:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-11T10:47:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-11T07:26:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-08-11T07:25:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bcaecc16-a1ec-4a70-bd69-120d6ab7e122","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-27T06:14:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 06:14:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7256353","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7256353","identity":"rs-7256353","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}