| Summary: | <span style="font-size: x-small;"><strong>Background</strong>: Disease management programmes are increasingly used to improve the efficacy and effectiveness of chronic care delivery.</span><span style="font-size: x-small;">But, disease management programme development and implementation is a complex undertaking that requires effective decision-making.</span><span style="font-size: x-small;">Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability.</span> <span style="font-size: x-small;"><strong>Methods</strong>: To increase our understanding of the choices that primary healthcare practices face when implementing such programmes and </span><span style="font-size: x-small;">to stimulate successful implementation and sustainability, we compared the early implementation of eight cardiovascular disease management </span><span style="font-size: x-small;">programmes initiated and managed by healthcare practices in various regions of the Netherlands. Using a mixed-methods design, we </span><span style="font-size: x-small;">identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management </span><span style="font-size: x-small;">level, healthcare utilisation costs, development costs and health-related quality of life.</span> <span style="font-size: x-small;"><strong>Results</strong>: Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, </span><span style="font-size: x-small;">professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable </span><span style="font-size: x-small;">implementation of cardiovascular disease management programmes, although development costs of the individual programmes varied </span><span style="font-size: x-small;">considerably in relation to the length of the development period. The large number of professionals involved in combination with duration </span><span style="font-size: x-small;">of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new </span><span style="font-size: x-small;">care pathways did not directly contribute to higher costs, delays in implementation indirectly did.</span> <span style="font-size: x-small;"><strong>Conclusions</strong>: Developing and implementing cardiovascular disease management programmes is time-consuming and challenging. Multidisciplinary, </span><span style="font-size: x-small;">patient-centred care demands multifaceted changes in routine care. As care pathways become more complex, they also </span><span style="font-size: x-small;">become more expensive. Better preparedness and training can prevent unnecessary delays during the implementation period and are crucial </span><span style="font-size: x-small;">to reducing costs.</span>
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