title: e-Vita: design of an innovative approach to COPD disease management in primary care through eHealth application.
abstract: BACKGROUND
  COPD is a highly complex disease to manage as patients show great variation in symptoms and limitations in daily life. In the last decade self-management support of COPD has been introduced as an effective method to improve quality and efficiency of care, and to reduce healthcare costs. Despite the urge to change the organisation of health care and the potential of eHealth to support this, large-scale implementation in daily practice remains behind, especially in the Netherlands.
  
  
  METHODS
  We designed a multilevel study, called e-Vita, to investigate different organisational implementation methods of a self-management web portal to support and empower patients with COPD in three different primary care settings. Using a parallel cohort design, the clinical effects of the web portal will be assessed using an interrupted times series (ITS) study design and measured according to changes in health status with the Clinical COPD Questionnaire (CCQ). The different implementations and net benefits of self-management through eHealth on clinical outcomes will be evaluated from human, organisational, and technical perspectives.
  
  
  CONCLUSIONS
  To our knowledge this is the first study to combine different study designs that enable simultaneous investigation of clinical effects, as well as effects of different organisational implementation methods whilst controlling for confounding effects of the organisational characteristics. We hypothesize that an implementation with higher levels of personal assistance, and integrated in an existing care program will result in increased use of and satisfaction with the platform, thereby increasing health status and diminishing exacerbation and hospitalisation.
  
  
  BACKGROUND
  NTR4098 (31-07-2013).
authors.affiliation: Public Health and Primary Care Department, LUMC, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. E.Talboom@saltro.nl.|SALTRO Diagnostic Centre, Mississippidreef 83, 3565 CE, Utrecht, The Netherlands. E.Talboom@saltro.nl.
authors.forename: E P W A
authors.initials: EP
authors.lastname: Talboom-Kamp
authors.affiliation: Public Health and Primary Care Department, LUMC, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.|SALTRO Diagnostic Centre, Mississippidreef 83, 3565 CE, Utrecht, The Netherlands.
authors.forename: N A
authors.initials: NA
authors.lastname: Verdijk
authors.affiliation: Zorgdraad Foundation, Wijnand van Arnhemweg 54, 6862XN, Oosterbeek, The Netherlands.
authors.forename: C M G
authors.initials: CM
authors.lastname: Blom
authors.affiliation: SALTRO Diagnostic Centre, Mississippidreef 83, 3565 CE, Utrecht, The Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Harmans
authors.affiliation: Zorgdraad Foundation, Wijnand van Arnhemweg 54, 6862XN, Oosterbeek, The Netherlands.
authors.forename: I J S H
authors.initials: IJ
authors.lastname: Talboom
authors.affiliation: Public Health and Primary Care Department, LUMC, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: Numans
authors.affiliation: Public Health and Primary Care Department, LUMC, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: N H
authors.initials: NH
authors.lastname: Chavannes
keywords: COPD; Chronically ill; Integrated disease management; Primary care; Self-management; Telemonitoring; eHealth