Responding to the burden of chronic disease presents challenges for all health systems. As populations age and advances in healthcare allow those with once-fatal conditions to survive, the prevalence of chronic conditions is rising in many countries.¹ In the European Union, in 2006, between 20 and over 40 per cent of the population aged 15 years and over reported a long-standing health problem and one in four currently receives medical long-term treatment.²

The implications for health systems and society as a whole are considerable. Chronic diseases pose a sizeable burden for national economies, with some studies estimating the associated costs...

Chronic conditions are defined by the World Health Organization (WHO) as requiring 'ongoing management over a period of years or decades' and cover a wide range of health problems.¹⁰ The goals of chronic care are not to cure but to enhance functional status, minimise distressing symptoms, prolong life through secondary prevention and enhance quality of life.¹¹ These goals are unlikely to be accomplished through the traditional acute, episodic model of care that is characterised by fragmentation of service delivery across professions and institutions. Indeed, chronic conditions frequently go untreated or are poorly controlled until more serious and acute complications arise....

Experimental research designs, particularly randomised controlled trials, are generally considered to be the most rigorous way of determining the effectiveness of a given intervention.⁸ In such designs individuals are randomly assigned to either the intervention group or a control group. Thereby, each person is given an equal chance to be chosen for the intervention so that any observed difference in outcome is not affected by systematic differences in factors, known and unknown, between those who receive a given intervention and those who do not.^60-61 However, use of an experimental design may not be possible (or desirable) for population-wide disease management...

Work undertaken within DISMEVAL has identified a range of challenges, which may be deemed necessary to consider for users, funders and researchers interested in the evaluation of structured approaches to chronic disease management. Some of the practical considerations concern the actual data to be used, such as their quality, completeness and sources, its accessibility and management, the availability of and familiarity with analytical tools and capacity, as well as broader issues around costs. This chapter will draw to a large extent on findings of work undertaken within DISMEVAL, providing illustrative examples from case studies where feasible and appropriate.

Data availability...

This chapter is aimed at reflecting on the broader lessons learned from work undertaken within the DISMEVAL project with regard to evaluation of structured approaches to disease management. We begin by briefly describing existing evaluation practice and needs as assessed in two case studies. We then elaborate specifically on the potential challenges associated with interpreting evaluation findings and how evaluation can be used to inform programme development and improvement.

Work carried out within the DISMEVAL project aimed to better understand the existing context for evaluation in European countries and the variation in evaluation needs and practices from the perspective of...

This report set out to bring together the findings of work undertaken in DISMEVAL to inform evidence-based recommendations for the use of various approaches to the evaluation of disease management in Europe and to identify examples of best practices and lessons learned. It aimed to explain choices, options and trade-offs to policymakers, programme operators and researchers.

In this concluding chapter, we draw together the evidence compiled from previous chapters and identify those factors that have emerged from work within DISMEVAL that might support the implementation of structured approaches to chronic disease management as discussed earlier.

We acknowledge that randomised controlled...