Bolíbar Ignasi, Plaza Vicente, Llauger Mariantònia, Amado Ester, Antón Pedro A, Espinosa Ana, Domínguez Leandra, Fraga Mar, Freixas Montserrat, de la Fuente Josep A, Liguerre Iskra, Medrano Casimira, Peiro Meritxell, Pou Mariantònia, Sanchis Joaquin, Solanes Ingrid, Valero Carles, Valverde Pepi
Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
BMC Public Health. 2009 Feb 24;9:68. doi: 10.1186/1471-2458-9-68.
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.
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.
在西班牙，慢性阻塞性肺疾病（COPD）患者的诊断和治疗仍然面临挑战，而当不同医疗级别之间缺乏协调的随访时，问题会更加严重。本文阐述了评估COPD患者综合管理模式影响的方案。新模型将从以下两个方面进行评估：1）改善医疗服务的合理利用；2）体现在患者健康状况和生活质量改善方面的益处。
方法/设计：一项关于名为COPD PROCESS的COPD管理模式有效性的准实验研究。研究队列中的患者将是西班牙巴塞罗那两家转诊医院所服务社区的居民。一个区域为干预组（n = 32248例患者），另一个为对照组（n = 32114例患者）。该研究将包括项目实施18个月后的干预前和干预后评估。分析将基于两个数据集：所有患者可用的临床和管理数据，以及从干预和对照区域随机抽取的440例患者队列的临床评估信息。主要终点将是两个医疗区域的住院率以及两个队列的生活质量指标。
COPD PROCESS模型预见通过协调的常规临床实践，对医疗系统不同层面的干预措施进行综合多学科管理。它将实施基于当前证据、多学科共识以及有效利用现有资源的诊断和治疗程序。该模型中的护理路径根据患者特征、疾病严重程度以及是否存在病情加重来定义。该方案涵盖了从一级预防到复杂病例治疗的全方位护理。
