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Bottom-up implementation of disease-management programmes: results of a multisite comparison
K M M Lemmens1, A P Nieboer, M P M H Rutten-Van Mölken
1Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. lemmens@bmg.eur.nl
BMJ Quality & Safety
|January 14, 2011
Summary
Implementing disease-management programs for chronic obstructive pulmonary disease (COPD) effectively addresses practice bottlenecks. Tailoring interventions to specific challenges in COPD care improves patient outcomes and quality of life.
Area of Science:
- Pulmonary Medicine
- Healthcare Management
- Health Services Research
Background:
- Chronic obstructive pulmonary disease (COPD) management requires effective disease-management programmes.
- Regional variations in COPD care present implementation challenges.
- Identifying and addressing practice bottlenecks is crucial for successful COPD management.
Purpose of the Study:
- To evaluate the implementation of three regional COPD disease-management programmes.
- To assess the impact of identified bottlenecks on programme effectiveness.
- To determine the relationship between intervention implementation and patient outcomes.
Main Methods:
- A multisite comparison of three Dutch regional COPD disease-management programmes.
- Data collection included process measures (Assessing Chronic Illness Care survey) and patient outcomes (quality of life, dyspnoea, patient experiences) from 370 patients and care providers.
- Interventions were selected based on identified bottlenecks in patient involvement, organizational issues, or both.
Main Results:
- Bottlenecks varied by region, focusing on patient involvement, organizational issues, or both.
- Significant improvements were observed in dyspnoea and patient experiences with practice nurses across programmes.
- Programme effectiveness varied; better intervention-bottleneck fit correlated with improved quality of life (COPD Assessment Test).
Conclusions:
- Bottom-up implementation of COPD disease-management programmes is feasible and can improve care outcomes.
- Aligning implemented interventions with identified practice bottlenecks enhances positive changes in patient outcomes.
- Optimizing COPD disease management requires a tailored approach addressing specific regional challenges.
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