The clinical effectiveness of the COPDnet integrated care model

E H Koolen; B van den Borst; M de Man; J C Antons; B Robberts; P N R Dekhuijzen; J H Vercoulen; M van den Heuvel; M A Spruit; P J van der Wees; A J van 't Hul

doi:10.1016/j.rmed.2020.106152

The clinical effectiveness of the COPDnet integrated care model

Respir Med. 2020 Oct:172:106152. doi: 10.1016/j.rmed.2020.106152. Epub 2020 Sep 12.

Authors

Affiliations

¹ Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands.
² Bernhoven, Department of Pulmonary Diseases, 5406 PT, Uden, the Netherlands.
³ Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 GA, Nijmegen, the Netherlands.
⁴ Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, 6229 HX, Maastricht, the Netherlands; Department of Research and Development, CIRO+, 6085 NM, Horn, the Netherlands; REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 BE, Diepenbeek, Belgium.
⁵ Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Department of Rehabilitation, 6525 GA, Nijmegen, the Netherlands.
⁶ Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands. Electronic address: alex.vanthul@radboudumc.nl.

PMID: 32956973
DOI: 10.1016/j.rmed.2020.106152

Abstract

Rationale: Integrated care models have the potential to improve outcomes for patients with COPD. We therefore designed the COPDnet integrated care model and implemented it in two hospitals and affiliated primary care regions in the Netherlands. The COPDnet model consists of a comprehensive diagnostic trajectory ran in secondary care followed by a non-pharmacological intervention program of both monodisciplinary and multidisciplinary components.

Objective: To assess the clinical effectiveness of the COPDnet integrated care model on health status change in patients with COPD.

Methods: A total of 402 patients with COPD were offered care according to the COPDnet model. At baseline and between 7- and 9-months later health status was measured with the Clinical COPD Questionnaire (CCQ). Primary analysis was carried out for the sample at large. In addition, subgroup analyses were performed after stratification for the type of non-pharmacological intervention where patients had been referred to.

Results: The CCQ total score improved statistically significantly from 1.94 ± 1.04 to 1.73 ± 0.96 (P < 0.01) in the 154 patients with valid follow-up measurements. Subgroup analyses revealed significant improvements in the patients receiving pulmonary rehabilitation only. No change in health status was found in patients receiving pharmacotherapy only, carried out self-treatment or who participated in mono-disciplinary primary care offered by allied healthcare professionals.

Conclusions: An improved health status was found in patients with COPD who received care according to the COPDnet integrated care model. Subgroups participating in an interdisciplinary pulmonary rehabilitation program predominantly accounted for this effect.

Publication types

Clinical Trial
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Delivery of Health Care, Integrated / methods*
Female
Health Status*
Humans
Male
Middle Aged
Netherlands
Prospective Studies
Pulmonary Disease, Chronic Obstructive / diagnosis*
Pulmonary Disease, Chronic Obstructive / rehabilitation
Pulmonary Disease, Chronic Obstructive / therapy*
Surveys and Questionnaires