Author ' s response to reviews Title : Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups : a case study

The conclusion is written in poor English and unclear. The focus of future efforts is vague and not based on answers in the article. The abstract’s conclusion was rewritten to increase its clarity and make it less vague. We clarified that integrated care in the Netherlands is still a work in progress, in the academic as well as practice setting. In general, the focus of future efforts is based on information that can be found at the following locations in the manuscript: • Future efforts should focus on the most problematic areas such as financial and health IT issues: o Financial issues: l.252-255, l.284288, l.307-311 o Health IT issues: l.434-481 • Future efforts should focus on those areas that have not received enough or any attention yet, such as: o patient involvement: l.152/l.699 (Table 1, section patient involvement), l.325-332, l.498500, l.520-522 o and community involvement: l.200-203, l.493-494, l.500-501 However, we understand from the reviewer’s comment that it was not clear from the article that these are what our study found to be the most problematic areas (interoperability of patient databases, negative consequences of financial incentives) or the areas that have not received enough attention yet (patient and community involvement). Therefore we pointed this out more clearly and directly in the results section of the abstract (see l.9798) and the results section (see l.252-255). l.126 Reviewer 2: Authors of articles should not generally be written in the text. We referenced unpublished materials as per the BMC Family Practice guidelines: “Only articles, clinical trial registration records and abstracts that have been published or are in press, or are available through public e-print/preprint servers, may be cited; unpublished abstracts, unpublished data and personal communications should not be included in the reference list, but may be included in the text and referred to as "unpublished observations" or "personal communications" giving the names of the involved researchers.“ http://www.biomedcentral.com/bmcfampra ct/authors/instructions/researcharticle#for matting-references l.126 Reviewer 2: The review articles are not listed in the bibliography We did not list the unpublished articles in the bibliography as per the journal’s manuscript guidelines (see previous). l.138 Reviewer 2: The article must distinguish between "the 2 care groups" and " the best practices" these seem to be used interchangeably. We changed this as indicated from “best practices” to “care groups” (l.138). Throughout the manuscript, we use the term “care group” to refer to legal entities that establish contracts with health insurers in order to coordinate and execute chronic care in a specified region. The two care groups we involved in our research are two of the approximately 100 legal entities currently delivering integrated diabetes care in the Netherlands. We use the term “best practice” to refer to the fact that the two care groups included in our research are seen as national and international best practices. We also use this term to refer to “best practices research”, i.e. the methodological approach to researching best practices. This distinction required no further changes in the manuscript, except the one indicated above, where we did not apply the above approach in a consequent way, as the reviewer correctly pointed out. l.139-144 Reviewer 2: Only the aim of the study needs stating not the study question. Changed as indicated: Instead of stating the research question, we explained the aim of the study, which was to find out how mechanism and context have influenced the outcomes of integrated care for type 2 diabetes. l.146-152 Reviewer 2: Explain terms such as "bundled care when they are first used. Bundled payments and related terms are first mentioned in l.149-151 and explained in Table 1 (l.152/l.699) directly afterwards. We added “see Table 1” to make this clearer for the reader. Because of the journal’s manuscript requirements Table 1 is included at the end of the document, but the manuscript should be read as if Table 1 is included in l.152 as indicated. l.151-152 Reviewer 2: No need to write Table 1 twice The second “Table 1” (l.152) acts as a placeholder for the actual table which is included at the end of the document (l.699) as per the journal’s manuscript requirements. l.159-161 Reviewer 2: There is no need to state when to use this study method. Changed as indicated (deleted).