Objective: This study explored associations among disease-management partnership functioning, synergy and effectiveness in the delivery of chronic-illness care. Design: This study had a cross-sectional design. Setting and participants: The study sample consists of 218 professionals (out of 393) participating in 22 disease-management partnerships in various regions of the Netherlands. Main outcome measures: We assessed the relationships among partnership functioning, synergy and effectiveness in the delivery of chronic-illness care. Partnership functioning was assessed through leadership, resources, administration and efficiency. Synergy was considered the proximal outcome of partnership functioning, which, in turn, influenced the effectiveness of disease-management partnerships [measured with the Assessment of Chronic Illness Care (ACIC) survey instrument]. Results: Overall ACIC scores ranged from 3 to 10, indicating basic/intermediate to optimal/comprehensive delivery of chronic-illness care. The results of the regression analysis demonstrate that partnership effectiveness was positively associated with leadership (β = 0.25; P≤ 0.01), and resources (β = 0.31; P≤ 0.001). No significant relationship was found between administration, efficiency and partnership effectiveness. Partnership synergy acted as a mediator for partnership functioning and was statistically significantly associated with partnership effectiveness (β = 0.25; P≤ 0.001). Conclusion: Disease-management partnerships seemed better able to deliver higher levels of chronic-illness care when synergy is created between partners. Synergy was more likely to emerge with boundary-spanning leaders who understood and appreciated partners' different perspectives, could bridge their diverse cultures and were comfortable sharing ideas, resources and power. In addition, the acknowledgement of and ability to use members' resources are valuable in engaging partners' involvement and achieving synergy in disease-management partnerships.

Chronic-illness care, Disease management, Partnership, Primary care, Quality, Synergy
dx.doi.org/10.1093/intqhc/mzs004, hdl.handle.net/1765/34942
International Journal for Quality in Health Care
Erasmus School of Health Policy & Management (ESHPM)

Cramm, J.M, & Nieboer, A.P. (2012). Disease-management partnership functioning, synergy and effectiveness in delivering chronic-illness care. International Journal for Quality in Health Care, 24(3), 279–285. doi:10.1093/intqhc/mzs004