Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands.
Bernhoven, Department of Pulmonary Diseases, 5406 PT, Uden, the Netherlands.
Respir Med. 2020 Oct;172:106152. doi: 10.1016/j.rmed.2020.106152. Epub 2020 Sep 12.
Integrated care models have the potential to improve outcomes for patients with COPD. We therefore designed the COPDnet integrated care model and implemented it in two hospitals and affiliated primary care regions in the Netherlands. The COPDnet model consists of a comprehensive diagnostic trajectory ran in secondary care followed by a non-pharmacological intervention program of both monodisciplinary and multidisciplinary components.
To assess the clinical effectiveness of the COPDnet integrated care model on health status change in patients with COPD.
A total of 402 patients with COPD were offered care according to the COPDnet model. At baseline and between 7- and 9-months later health status was measured with the Clinical COPD Questionnaire (CCQ). Primary analysis was carried out for the sample at large. In addition, subgroup analyses were performed after stratification for the type of non-pharmacological intervention where patients had been referred to.
The CCQ total score improved statistically significantly from 1.94 ± 1.04 to 1.73 ± 0.96 (P < 0.01) in the 154 patients with valid follow-up measurements. Subgroup analyses revealed significant improvements in the patients receiving pulmonary rehabilitation only. No change in health status was found in patients receiving pharmacotherapy only, carried out self-treatment or who participated in mono-disciplinary primary care offered by allied healthcare professionals.
An improved health status was found in patients with COPD who received care according to the COPDnet integrated care model. Subgroups participating in an interdisciplinary pulmonary rehabilitation program predominantly accounted for this effect.
综合护理模式有可能改善 COPD 患者的预后。因此，我们设计了 COPDnet 综合护理模式，并在荷兰的两家医院和附属初级保健区实施。COPDnet 模式包括在二级保健中进行全面的诊断轨迹，然后进行非药物干预计划，包括单学科和多学科的组成部分。
评估 COPDnet 综合护理模式对 COPD 患者健康状况变化的临床效果。
共 402 例 COPD 患者接受 COPDnet 模式的护理。在基线和 7-9 个月后，使用临床 COPD 问卷（CCQ）测量健康状况。对总体样本进行了主要分析。此外，还对接受非药物干预的患者进行了分层后进行了亚组分析。
在有有效随访测量的 154 例患者中，CCQ 总分从 1.94±1.04 显著改善至 1.73±0.96（P<0.01）。亚组分析显示，仅接受肺康复治疗的患者有显著改善。仅接受药物治疗、自我治疗或接受联合医疗保健专业人员提供的单学科初级保健的患者，健康状况无变化。
根据 COPDnet 综合护理模式接受护理的 COPD 患者健康状况得到改善。主要是参与跨学科肺康复计划的亚组患者有此效果。
