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BMC Health Services Research
Published in: BMC Health Services Research 1/2010

Open Access 01-12-2010 | Research article

Application of a theoretical model to evaluate COPD disease management

Authors: Karin MM Lemmens, Anna P Nieboer, Maureen PMH Rutten-Van Mölken, Constant P van Schayck, Javier D Asin, Jos AM Dirven, Robbert Huijsman

Published in: BMC Health Services Research | Issue 1/2010

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Abstract

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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Metadata
Title
Application of a theoretical model to evaluate COPD disease management
Authors
Karin MM Lemmens
Anna P Nieboer
Maureen PMH Rutten-Van Mölken
Constant P van Schayck
Javier D Asin
Jos AM Dirven
Robbert Huijsman
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2010
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-81

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