Long-term effectiveness of a primary care chronic disease management program in Korea

This study evaluated the long-term effectiveness of Korea's Primary Care Chronic Disease Management Program (CDMP) on major clinical outcomes among patients with type 2 diabetes mellitus (T2DM).

Patients aged ≥18 years who received outpatient care for T2DM in 2019 were identified using Korea's National Health Insurance Claims Database. Patients with a prior history of inpatient or outpatient care for ischemic heart disease (IHD) or stroke, or a history of hospitalization for diabetes before the index date were excluded. The final cohort included 1,817,682 patients, who were followed from the index date to December 31, 2023, for preventable diabetes-related hospitalization and incident IHD and stroke. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

The study included 49,449 CDMP participants and 1,768,233 non-participants. The mean ages of the CDMP and non-CDMP groups were 62.2 years and 61.5 years, respectively. Compared with non-participants, CDMP participants had significantly lower risks of any adverse health outcome (HR, 0.87; 95% CI, 0.85 to 0.89), IHD (HR, 0.94; 95% CI, 0.91 to 0.97), stroke (HR, 0.85; 95% CI, 0.82 to 0.89), and diabetes-related hospitalization (HR, 0.73; 95% CI, 0.70 to 0.76).

Participation in the CDMP was associated with improved long-term health outcomes among patients with T2DM. These findings support the importance of continuous, structured, primary care-based chronic disease management and provide empirical evidence for expanding and institutionalizing the CDMP within Korea's National Health Insurance system.