Koolen Eleonore H, van der Wees Philip J, Westert Gert P, Dekhuijzen Richard, Heijdra Yvonne F, van 't Hul Alex J
Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands,
Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands.
Int J Chron Obstruct Pulmon Dis. 2018 Jul 19;13:2237-2244. doi: 10.2147/COPD.S153992. eCollection 2018.
Projections on the future suggest a further rise in the prevalence of patients with COPD, and in COPD related morbidity, mortality, and health care costs worldwide. Given the substantial impact on the individual and on society, it is important to establish a care process that maximizes outcomes in relation to the costs and efforts made. In an attempt to bridge this gap, we set out to develop an evidence-based model of integrated care for patients with COPD, named the COPDnet integrated care model.
The current study protocol sets out to 1) evaluate the feasibility of employing the COPDnet model in present real-life care within the context of the Dutch health care system, 2) explore the potential health status benefits, and 3) analyze the costs of care of this model.
In this prospective study, feasibility and health status changes will be evaluated with an experimental before and after study design. The costs of the diagnostic trajectory will be calculated according to a standard economic health care evaluation approach. Furthermore, the feasibility and cost of care studies will comprise both quantitative and qualitative data collection. For the studies on the feasibility and change in health status, all new patients qualifying for shared care by primary and secondary care professionals according to the Dutch Standard of Care for COPD, and patients referred by their general practitioners to one of the COPDnet hospitals will be included. To evaluate the feasibility and costs of care, semi-structured interviews will be held with patients, hospital personnel, health care professionals in the affiliated primary care region, and hospital and primary care group managers.
The COPDnet integrated care model for COPD patients has been designed according to the current insights regarding effective care for patients with a chronic condition in general, and for patients with COPD in particular. It will be evaluated for its feasibility, potential health status benefits, and the costs of care of the diagnostic trajectory in secondary care.
对未来的预测表明，慢性阻塞性肺疾病（COPD）患者的患病率、与COPD相关的发病率、死亡率以及全球医疗保健成本将进一步上升。鉴于其对个人和社会的重大影响，建立一个能使结果与成本和付出相匹配的护理流程非常重要。为了填补这一差距，我们着手开发一种基于证据的COPD患者综合护理模式，即COPDnet综合护理模式。
本研究方案旨在1）评估在荷兰医疗保健系统背景下，将COPDnet模式应用于当前实际护理中的可行性，2）探索潜在的健康状况益处，3）分析该模式的护理成本。
在这项前瞻性研究中，将采用前后对照的实验性研究设计来评估可行性和健康状况变化。诊断轨迹的成本将根据标准的经济医疗保健评估方法进行计算。此外，护理可行性和成本研究将包括定量和定性数据收集。对于可行性和健康状况变化的研究，所有符合荷兰COPD护理标准、由初级和二级护理专业人员进行共享护理的新患者，以及由全科医生转诊至COPDnet医院之一的患者都将被纳入。为了评估护理的可行性和成本，将与患者、医院工作人员、附属初级护理区域的医疗保健专业人员以及医院和初级护理组管理人员进行半结构化访谈。
COPD患者的COPDnet综合护理模式是根据目前对慢性病患者（尤其是COPD患者）有效护理的认识而设计的。将对其在二级护理中的可行性、潜在的健康状况益处以及诊断轨迹的护理成本进行评估。
