Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK.
Barts Health, NHS Trust, London, UK.
NPJ Prim Care Respir Med. 2014 Oct 16;24:14082. doi: 10.1038/npjpcrm.2014.82.
Structured care for people with chronic obstructive pulmonary disease (COPD) can improve outcomes. Delivering care in a deprived ethnically diverse area can prove challenging.
Evaluation of a system change to enhance COPD care delivery in a primary care setting between 2010 and 2013 using observational data.
All 36 practices in one inner London primary care trust were grouped geographically into eight networks of 4-5 practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary group, including a respiratory specialist and the community respiratory team, developed a 'care package' for COPD management, with financial incentives based on network achievements of clinical targets and supported case management and education. Monthly electronic dashboards enabled networks to track and improve performance.
The size of network COPD registers increased by 10% in the first year. Between 2010 and 2013 completed care plans increased from 53 to 86.5%, pulmonary rehabilitation referrals rose from 45 to 70% and rates of flu immunisation from 81 to 83%, exceeding London and England figures. Hospital admissions decreased in Tower Hamlets from a historic high base.
Investment of financial, organisational and educational resource into general practice networks was associated with clinically important improvements in COPD care in socially deprived, ethnically diverse communities. Key behaviour change included the following: collaborative working between practices driven by high-quality information to support performance review; shared financial incentives; and engagement between primary and secondary care clinicians.
对慢性阻塞性肺疾病（COPD）患者进行结构化护理可以改善预后。在贫困且种族多样化的地区提供护理可能具有挑战性。
利用观察性数据评估 2010 年至 2013 年期间在初级保健环境中改变系统以增强 COPD 护理提供的效果。
将伦敦一个初级保健信托机构的所有 36 家诊所按地理位置分为 8 个网络，每个网络由 4-5 个诊所组成，每个网络都由网络经理、文员和教育预算支持。一个多学科小组，包括呼吸科专家和社区呼吸团队，为 COPD 管理制定了“护理包”，根据网络在临床目标和支持病例管理和教育方面的成就，提供财务激励。每月的电子仪表板使网络能够跟踪和提高绩效。
网络 COPD 登记册的规模在第一年增加了 10%。2010 年至 2013 年，完成的护理计划从 53%增加到 86.5%，肺康复转诊从 45%增加到 70%，流感疫苗接种率从 81%增加到 83%，超过了伦敦和英格兰的数据。在塔哈姆雷特，医院的入院率从历史高位下降。
将财务、组织和教育资源投入到基层医疗网络中，与贫困且种族多样化社区中 COPD 护理的临床显著改善相关。关键的行为改变包括以下内容：由高质量信息驱动的实践之间的协作，以支持绩效审查；共享财务激励措施；以及初级保健和二级保健临床医生之间的参与。
