Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease
Por:
Bolibar, I, Plaza, V, Llauger, M, Amado, E, Anton, PA, Espinosa, A, Dominguez, L, Fraga, M, Freixas, M, de la Fuente, JA, Liguerre, I, Medrano, C, Peiro, M, Pou, M, Sanchis, J, Solanes, I, Valero, C, Valverde, P
Publicada:
24 feb 2009
Resumen:
Background: The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients.
Methods/Design: A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts.
Discussion: The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases.
Filiaciones:
Bolibar, I:
Autonomous Univ Barcelona, CIBER Epidemiol & Publ Hlth, Hosp Santa Creu & St Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Plaza, V:
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, Dept Resp Med, Barcelona, Spain
Llauger, M:
Catalan Hlth Inst, CAP Maragall, EAP Encants, Barcelona, Spain
Anton, PA:
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, Dept Resp Med, Barcelona, Spain
Espinosa, A:
Autonomous Univ Barcelona, CIBER Epidemiol & Publ Hlth, Hosp Santa Creu & St Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Dominguez, L:
Catalan Hlth Inst, CAP Maragall, EAP Encants, Barcelona, Spain
Fraga, M:
Catalan Hlth Inst, EAP Xafarinas, Barcelona, Spain
Freixas, M:
EAP Dreta Eixample, Barcelona, Spain
de la Fuente, JA:
Catalan Hlth Inst, SAP Badalona St Adria, Badalona, Spain
Liguerre, I:
Catalan Hlth Inst, CAP St Andreu, Badalona, Spain
Medrano, C:
Catalan Hlth Inst, EAP Clot, Badalona, Spain
Peiro, M:
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, Dept Resp Med, Barcelona, Spain
Pou, M:
Catalan Hlth Inst, CAP Maragall, EAP Encants, Barcelona, Spain
Sanchis, J:
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, Dept Resp Med, Barcelona, Spain
Solanes, I:
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, Dept Resp Med, Barcelona, Spain
Valero, C:
Catalan Hlth Inst, SAP Dreta, Badalona, Spain
Valverde, P:
EAP Gaudi CAP Sagrada Familia, Barcelona, Spain
Gold, Green Published
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