Gómez-López Alba, Arismendi Ebymar, Cano Isaac, Farre Ramón, Figols María, Hernández Carme, Montilla-Ibarra Antonio, Sánchez-Ruano Núria, Sánchez Benigno, Sisó-Almirall Antoni, Sorribes Marta, Vela Emili, Piera-Jiménez Jordi, Benavent Jaume, Fermoso Jose, Roca Josep, González-Colom Rubèn
Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain.
Pulmonology Department, Hospital Clinic de Barcelona, Barcelona, Spain
BMJ Open Respir Res. 2025 Jan 20;12(1):e002589. doi: 10.1136/bmjresp-2024-002589.
Reducing unplanned hospital admissions in chronic patients at risk is a key area for action due to the high healthcare and societal burden of the phenomenon. The inconclusive results of preventive strategies in patients with chronic obstructive respiratory disorders and comorbidities are explainable by multifactorial but actionable factors.The current protocol (January 2024-December 2025) relies on the hypothesis that intertwined actions in four dimensions: (1) management change, (2) personalisation of the interventions based on early detection/treatment of acute episodes and enhanced management of comorbidities, (3) mature digital support and (4) comprehensive assessment, can effectively overcome most of the limitations shown by previous preventive strategies. Accordingly, the main objective is to implement a novel integrated care preventive service for enhanced management of these patients, as well as to evaluate its potential for value generation.
At the end of 2024, the specifics of the novel service will be defined through the articulation of its four main components: (1) enhanced lung function testing through oscillometry, (2) continuous monitoring of indoor air quality as a potential triggering factor, (3) digital support with an adaptive case management (ACM) approach and (4) predictive modelling for early identification and management of exacerbations. During 2025, the novel service will be assessed using a Quintuple Aim approach. Moreover, the Consolidated Framework for Implementation Research will be applied to assess the implementation. The service components will be articulated through four sequential 6-month plan-do-study-act cycles. Each cycle involves a targeted cocreation process following a mixed-methods approach with the active participation of patients, health professionals, managers and digital experts.
The Ethics Committee for Human Research at Hospital Clinic de Barcelona approved the protocol on 29 June 2023 (HCB/2023/0126). Before any procedure, all patients in the study must sign an informed consent form.
NCT06421402.
由于这一现象给医疗保健和社会带来的沉重负担，减少高危慢性病患者的非计划性住院是一个关键行动领域。慢性阻塞性呼吸道疾病及合并症患者预防策略的结果尚无定论，这可由多因素但可采取行动的因素来解释。当前方案（2024年1月至2025年12月）基于这样一种假设，即四个维度的相互交织的行动：（1）管理变革，（2）基于急性发作的早期检测/治疗和合并症强化管理的干预措施个性化，（3）成熟的数字支持，以及（4）综合评估，能够有效克服先前预防策略所显示的大多数局限性。因此，主要目标是实施一项新型综合护理预防服务，以加强对这些患者的管理，并评估其产生价值的潜力。
2024年底，将通过阐述其四个主要组成部分来确定新型服务的具体内容：（1）通过振荡法加强肺功能测试，（2）持续监测室内空气质量作为潜在触发因素，（3）采用适应性病例管理（ACM）方法提供数字支持，以及（4）用于早期识别和管理病情加重的预测模型。2025年期间，将采用五重目标方法评估新型服务。此外，将应用实施研究综合框架来评估实施情况。服务组成部分将通过四个连续的为期6个月的计划-执行-研究-行动周期来阐述。每个周期都涉及一个有针对性的共同创造过程，采用混合方法，患者、卫生专业人员、管理人员和数字专家积极参与。
巴塞罗那医院临床中心人类研究伦理委员会于2023年6月29日批准了该方案（HCB/2023/0126）。在进行任何程序之前，研究中的所有患者必须签署知情同意书。
NCT06421402。
