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Application of a theoretical model to evaluate COPD disease management

BACKGROUND: Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of...

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Autores principales: Lemmens, Karin MM, Nieboer, Anna P, Rutten-Van Mölken, Maureen PMH, van Schayck, Constant P, Asin, Javier D, Dirven, Jos AM, Huijsman, Robbert
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859741/
https://www.ncbi.nlm.nih.gov/pubmed/20346135
http://dx.doi.org/10.1186/1472-6963-10-81
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author Lemmens, Karin MM
Nieboer, Anna P
Rutten-Van Mölken, Maureen PMH
van Schayck, Constant P
Asin, Javier D
Dirven, Jos AM
Huijsman, Robbert
author_facet Lemmens, Karin MM
Nieboer, Anna P
Rutten-Van Mölken, Maureen PMH
van Schayck, Constant P
Asin, Javier D
Dirven, Jos AM
Huijsman, Robbert
author_sort Lemmens, Karin MM
collection PubMed
description BACKGROUND: Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting. METHODS: A quasi-experimental research was performed with 12-months follow-up of 189 COPD patients in primary care in the Netherlands. The programme included patient education, protocolised assessment and treatment of COPD, structural follow-up and coordination by practice nurses at 3, 6 and 12 months. Data on intermediate outcomes (knowledge, psychosocial mediators, self-efficacy and behaviour) and final outcomes (dyspnoea, quality of life, measured by the CRQ and CCQ, and patient experiences) were obtained from questionnaires and electronic registries. RESULTS: Implementation of the programme was associated with significant improvements in dyspnoea (p < 0.001) and patient experiences (p < 0.001). No significant improvement was found in mean quality of life scores. Improvements were found in several intermediate outcomes, including investment beliefs (p < 0.05), disease-specific knowledge (p < 0.01; p < 0.001) and medication compliance (p < 0.01). Overall, process improvement was established. The model showed associations between significantly improved intermediate outcomes and improvements in quality of life and dyspnoea. CONCLUSIONS: The application of a theory-driven model enhances the design and evaluation of disease management programmes aimed at improving health outcomes. This study supports the notion that a theoretical approach strengthens the evaluation designs of complex interventions. Moreover, it provides prudent evidence that the implementation of COPD disease management programmes can positively influence outcomes of care.
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spelling pubmed-28597412010-04-27 Application of a theoretical model to evaluate COPD disease management Lemmens, Karin MM Nieboer, Anna P Rutten-Van Mölken, Maureen PMH van Schayck, Constant P Asin, Javier D Dirven, Jos AM Huijsman, Robbert BMC Health Serv Res Research article BACKGROUND: Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting. METHODS: A quasi-experimental research was performed with 12-months follow-up of 189 COPD patients in primary care in the Netherlands. The programme included patient education, protocolised assessment and treatment of COPD, structural follow-up and coordination by practice nurses at 3, 6 and 12 months. Data on intermediate outcomes (knowledge, psychosocial mediators, self-efficacy and behaviour) and final outcomes (dyspnoea, quality of life, measured by the CRQ and CCQ, and patient experiences) were obtained from questionnaires and electronic registries. RESULTS: Implementation of the programme was associated with significant improvements in dyspnoea (p < 0.001) and patient experiences (p < 0.001). No significant improvement was found in mean quality of life scores. Improvements were found in several intermediate outcomes, including investment beliefs (p < 0.05), disease-specific knowledge (p < 0.01; p < 0.001) and medication compliance (p < 0.01). Overall, process improvement was established. The model showed associations between significantly improved intermediate outcomes and improvements in quality of life and dyspnoea. CONCLUSIONS: The application of a theory-driven model enhances the design and evaluation of disease management programmes aimed at improving health outcomes. This study supports the notion that a theoretical approach strengthens the evaluation designs of complex interventions. Moreover, it provides prudent evidence that the implementation of COPD disease management programmes can positively influence outcomes of care. BioMed Central 2010-03-26 /pmc/articles/PMC2859741/ /pubmed/20346135 http://dx.doi.org/10.1186/1472-6963-10-81 Text en Copyright ©2010 Lemmens et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research article
Lemmens, Karin MM
Nieboer, Anna P
Rutten-Van Mölken, Maureen PMH
van Schayck, Constant P
Asin, Javier D
Dirven, Jos AM
Huijsman, Robbert
Application of a theoretical model to evaluate COPD disease management
title Application of a theoretical model to evaluate COPD disease management
title_full Application of a theoretical model to evaluate COPD disease management
title_fullStr Application of a theoretical model to evaluate COPD disease management
title_full_unstemmed Application of a theoretical model to evaluate COPD disease management
title_short Application of a theoretical model to evaluate COPD disease management
title_sort application of a theoretical model to evaluate copd disease management
topic Research article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859741/
https://www.ncbi.nlm.nih.gov/pubmed/20346135
http://dx.doi.org/10.1186/1472-6963-10-81
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