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Open Access Highly Accessed Study protocol

The effectiveness of case management for comorbid diabetes type 2 patients; the CasCo study. Design of a randomized controlled trial

Nathalie Versnel123*, Laura MC Welschen23, Caroline A Baan234, Giel Nijpels23 and François G Schellevis123

Author Affiliations

1 NIVEL, Netherlands Institute for Health Services Research, P.O.Box 1568, 3500 BN Utrecht, The Netherlands

2 EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands

3 Department of General Practice, VU University Medical Centre, v.d. Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

4 Centre for Prevention and Health Services Research, National Institute of Public Health and the Environment (RIVM), P.O.Box 1, 3720 BA Bilthoven, The Netherlands

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BMC Family Practice 2011, 12:68  doi:10.1186/1471-2296-12-68

Published: 5 July 2011



More than half of the patients with type 2 diabetes (T2DM) patients are diagnosed with one or more comorbid disorders. They can participate in several single-disease oriented disease management programs, which may lead to fragmented care because these programs are not well prepared for coordinating care between programs. Comorbid patients are therefore at risk for suboptimal treatment, unsafe care, inefficient use of health care services and unnecessary costs. Case management is a possible model to counteract fragmented care for comorbid patients. It includes evidence-based optimal care, but is tailored to the individual patients' preferences.

The objective of this study is to examine the effectiveness of a case management program, in addition to a diabetes management program, on the quality of care for comorbid T2DM patients.


The study is a randomized controlled trial among patients with T2DM and at least one comorbid chronic disease (N = 230), who already participate in a diabetes management program. Randomization will take place at the level of the patients in general practices. Trained practice nurses (case managers) will apply a case management program in addition to the diabetes management program. The case management intervention is based on the Guided Care model and includes six elements; assessing health care needs, planning care, create access to other care providers and community resources, monitoring, coordinating care and recording of all relevant information. Patients in the control group will continue their participation in the diabetes management program and receive care-as-usual from their general practitioner and other care providers.


We expect that the case management program, which includes better structured care based on scientific evidence and adjusted to the patients' needs and priorities, will improve the quality of care coordination from both the patients' and caregivers' perspective and will result in less consumption of health care services.

Trial registration

Netherlands Trial Register (NTR): NTR1847