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

Objectives: 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).Methods: 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). Results:The study included 49,449 CDMP participants and 1,768,233 nonparticipants.The mean ages of the CDMP and non-CDMP groups were 62.2 and 61.5 years, respectively.Compared with nonparticipants, CDMP participants had significantly lower risks of any adverse health outcome (HR, 0.867; 95% CI, 0.848 to 0.887), IHD (HR, 0.940; 95% CI, 0.917 to 0.969), stroke (HR, 0.851; 95% CI, 0.817 to 0.887), and diabetes-related hospitalization (HR, 0.729; 95% CI, 0.696 to 0.764).Conclusions: 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.