title: Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients.
  
  
  METHODS
  A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts.
  
  
  CONCLUSIONS
  The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases.
authors.affiliation: Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain. ibolibar@santpau.cat
authors.forename: Ignasi
authors.initials: I
authors.lastname: Bolíbar
authors.forename: Vicente
authors.initials: V
authors.lastname: Plaza
authors.forename: Mariantònia
authors.initials: M
authors.lastname: Llauger
authors.forename: Ester
authors.initials: E
authors.lastname: Amado
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Antón
authors.forename: Ana
authors.initials: A
authors.lastname: Espinosa
authors.forename: Leandra
authors.initials: L
authors.lastname: Domínguez
authors.forename: Mar
authors.initials: M
authors.lastname: Fraga
authors.forename: Montserrat
authors.initials: M
authors.lastname: Freixas
authors.forename: Josep A
authors.initials: JA
authors.lastname: de la Fuente
authors.forename: Iskra
authors.initials: I
authors.lastname: Liguerre
authors.forename: Casimira
authors.initials: C
authors.lastname: Medrano
authors.forename: Meritxell
authors.initials: M
authors.lastname: Peiro
authors.forename: Mariantònia
authors.initials: M
authors.lastname: Pou
authors.forename: Joaquin
authors.initials: J
authors.lastname: Sanchis
authors.forename: Ingrid
authors.initials: I
authors.lastname: Solanes
authors.forename: Carles
authors.initials: C
authors.lastname: Valero
authors.forename: Pepi
authors.initials: P
authors.lastname: Valverde
mesh_terms: D019468:Disease Management; D005069:Evaluation Studies as Topic; D006801:Humans; D010346:Patient Care Management / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods*; D017064:Process Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*