Senior Researcher, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Senior Researcher Researcher, National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, The Netherlands PhD Student/Researcher, National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, The Netherlands and Department of Integrated Care, TRANZO, Tilburg University, Tilburg, The Netherlands Senior Researcher, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands Senior Researcher, Health Technology and Services Research, University of Twente, Enschede,The Netherlands Professor, Department of Integrated Care, TRANZO, Tilburg University, Tilburg, the Netherlands and Senior Researcher, Care and Public Health Research Institute (CAPHRI) and Department of Integrated Care, Maastricht University Medical Centre, Maastricht, The Netherlands Senior Researcher, National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, The Netherlands.
J Eval Clin Pract. 2013 Oct;19(5):734-52. doi: 10.1111/j.1365-2753.2011.01805.x. Epub 2011 Dec 2.
RATIONALE, AIMS AND OBJECTIVES: Clinical diversity and methodological heterogeneity exists between studies on chronic care management. This study aimed to examine the effectiveness of chronic care management in chronic obstructive pulmonary disease (COPD) while taking heterogeneity into account, enabling the understanding of and the decision making about such programmes. Three investigated sources of heterogeneity were study quality, length of follow-up, and number of intervention components.
We performed a review of previously published reviews and meta-analyses on COPD chronic care management. Their primary studies that were analyzed as statistical, clinical and methodological heterogeneity were present. Meta-regression analyses were performed to explain the variances among the primary studies.
Generally, the included reviews showed positive results on quality of life and hospitalizations. Inconclusive effects were found on emergency department visits and no effects on mortality. Pooled effects on hospitalizations, emergency department visits and quality of life of primary studies did not reach significant improvement. No effects were found on mortality. Meta-regression showed that the number of components of chronic care management programmes explained present heterogeneity for hospitalizations and emergency department visits. Four components showed significant effects on hospitalizations, whereas two components had significant effects on emergency department visits. Methodological study quality and length of follow-up did not significantly explain heterogeneity.
This study demonstrated that COPD chronic care management has the potential to improve outcomes of care; heterogeneity in outcomes was explained. Further research is needed to elucidate the diversity between COPD chronic care management studies in terms of the effects measured and strengthen the support for chronic care management.
背景、目的和目标：慢性疾病管理的研究之间存在临床多样性和方法学异质性。本研究旨在探讨慢性阻塞性肺疾病（COPD）慢性疾病管理的有效性，同时考虑到异质性，以便理解和决策此类方案。研究考察了三个异质性来源，分别是研究质量、随访时间和干预措施的数量。
我们对 COPD 慢性疾病管理的已发表综述和荟萃分析进行了综述，这些综述的主要研究均存在统计学、临床和方法学异质性。采用荟萃回归分析解释主要研究之间的差异。
总体而言，纳入的综述在生活质量和住院率方面显示出积极的结果。在急诊就诊和死亡率方面的效果不确定。对住院、急诊就诊和生活质量的汇总效果没有显著改善。对死亡率没有影响。荟萃回归显示，慢性疾病管理方案的组件数量可以解释住院和急诊就诊的异质性。四个组件对住院有显著影响，两个组件对急诊就诊有显著影响。方法学研究质量和随访时间没有显著解释异质性。
本研究表明，COPD 慢性疾病管理有可能改善护理结果；对结果的异质性进行了解释。需要进一步研究阐明 COPD 慢性疾病管理研究在测量效果方面的多样性，并加强对慢性疾病管理的支持。
