Background
Methods
Aim
Materials
Model Elements | Components |
---|---|
Community resources and policy | Links with community services and resources |
Self-management support | Carer and family support |
Patient behaviour-change interventions, e.g. pulmonary rehabilitation | |
Self-management support strategies | |
Delivery system design | Regular patient follow-up |
Care provided by a multi-disciplinary team | |
Integration of care between primary and secondary sectors | |
Integrating palliative care into the community | |
Decision Support | Evidence based guidelines |
Involving specialists to improve the care delivered by the team | |
Continuing professional development and advanced training for the team | |
Clinical information systems | Individual patient care/treatment plans |
Disease registers of COPD patients | |
Performance monitoring of the COPD team | |
Identifying relevant subgroups of patients for care |
Sample
Design
Analysis
General consensus | 1. Median and interquartile range fall within one priority level only |
2. Mean standard deviation extends beyond one level of the scale and outliers are present. | |
Full consensus | 1. Median and interquartile range fall within one priority level only |
2. Mean standard deviation extends beyond one level of the scale but no outliers are present. | |
Pure consensus | 1. Median and interquartile range fall within one priority level only |
2. Mean standard deviation lies within one level of the scale and no outliers are present. |
Ethical issues
Results
Respondents
Invited (n) | Round 1 | Round 2 | Round 3 |
---|---|---|---|
n | n | n | |
Consultant respiratory physician (2) | 2 | 2 | 2 |
Respiratory specialist (4) | 4 | 3 | 2 |
Respiratory physiology lead (1) | 0 | 0 | 0 |
General practitioner (3) | 3 | 2 | 3 |
Primary care academic (3) | 2 | 3 | 3 |
Respiratory specialist nurse (2) | 1 | 0 | 0 |
Community respiratory nurse (1) | 0 | 0 | 0 |
Practice nurse (1) | 1 | 1 | 0 |
Commissioning lead (2) | 2 | 2 | 2 |
Practice based commissioning manager (1) | 1 | 1 | 1 |
Team manager (1) | 0 | 0 | 0 |
Total | 16 | 14 | 13 |
The survey
Model Elements | Additional Components |
---|---|
Community resources and policy | Fuel poverty |
Lifestyle | |
Air pollution | |
Self-management support | Telephone helpline |
Smoking cessation | |
Delivery system design | Transport is available to the place of delivery |
A range of community locations | |
Delivery in the patient home | |
End of life care | |
Long term oxygen therapy | |
Acute exacerbations | |
Rapid access to diagnostics | |
Decision support | n/a |
Clinical information systems | n/a |
Final components
Type of consensus met | Component | Standard to which component should be met | Level of priority | |
---|---|---|---|---|
Original components
|
General
| Integrating care between primary and secondary sectors | A high priority and all chronic disease interventions include active coordination between primary care, specialists and other relevant groups. | High |
Performance monitoring of the COPD team | Is timely, specific to the team, routine and personally delivered by a respected opinion leader to improve team performance. | High | ||
Individual patient care/treatment plans | Established collaboratively and include self management as well as clinical management. Follow-up occurs and guides care at every point of service. | High | ||
Full
| Continuing professional development and advanced training for the team | Include training in all practice teams in chronic illness care methods such as population-based management, and self-management support. | High | |
Integrating palliative care into the community | N/A | High | ||
Links with community services and resources | Actively sought to develop formal supportive programs in order and policies across the entire system. | High | ||
Carer and family support | An integral part of care and includes systematic assessment and routine involvement in peer support, groups or mentoring programs. | High | ||
Self-management support strategies | Provided by trained clinical educators who are designed to do self-management support, affiliated with each practice, and who see patients on referral. | High | ||
Pure
| Evidence based guidelines | Available, supported by provider education and integrated into care through reminders and other proven provider behaviour | High | |
Care provided by a multi-disciplinary team | Assured by regular team meetings to address guidelines, roles and accountability, and problems in chronic illness care. | High | ||
Disease registers of COPD patients | Tied to guidelines which provide prompts and reminders about needed services. | High | ||
Patient behaviour-change interventions, e.g. pulmonary rehabilitation | Readily available and an integral part of routine care. | High | ||
Additional components
|
General
| Acute exacerbation | N/A | High |
Full
| Smoking cessation | N/A | High | |
End-of-life care | N/A | High | ||
Long-term oxygen therapy | N/A | High |
Discussion
Summary of main findings
Strengths and limitations of the study
Comparison with existing literature
Implications for practice
No. of components | Self- management | Delivery system design | Decision support | Clinical information systems | |
---|---|---|---|---|---|
1 | Farrero et al. 2001 | X | |||
Weinberger et al. 2002 | X | ||||
Brough et al. 1982; Cockcroft et al. 1987; Howland et al. 1986; Littlejohns et al. 1991 Zimmerman et al. 1996 | X | ||||
Goransson et al. 2003; Emery et al. 1998 | X | ||||
2 | Steinel and Madigan 2003 | X | X | ||
Haggerty et al. 1991; Hermiz et al. 2002; Hernandez et al. 2003 | X | X | |||
Monninkhof et al. 2003 | X | X | |||
3 | Bourbeau et al. 2003; Neff et al. 2003 | X | X | X | |
4 | Barnett 2003 | X | X | X | X |
Rea et al. 2004 | X | X | X | X |
No. of model elements | Successful combinations | |||||
---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | No. | Model Element | |
Knowledge
| 2 sig (Emery et al. 1998; Goransson et al. 2003) 2 n/s (Brough et al. 1982; Cockcroft et al. 1987) | 2 sig (Hermiz et al. 2002; Hernandez et al. 2003) | n/a | n/a | 1 | Self-management |
2 | Self-management | |||||
Delivery system design | ||||||
Dyspnoea
| 1 n/s (Zimmerman et al. 1996) | 2 n/s (Hermiz et al. 2002; Monninkhof et al. 2003) | 1 sig (Neff et al. 2003) 1 n/s (Bourbeau et al 2003) | n/a | 3 | Self-management |
Delivery system design | ||||||
Decision support | ||||||
Quality of life
| 4 n/s (Emery et al. 1998; Weinberger et al. 2002; Cockcroft et al. 1987; Littlejohns et al. 1991) | 2 n/s (Hermiz et al. 2002; Monninkhof et al. 2003) | 1 sig (Neff et al. 2003) 1 n/s (Bourbeau et al. 2003) | n/a | 3 | Self-management |
Delivery system design | ||||||
Decision support | ||||||
Lung function
| n/a | n/a | n/a | 1 sig (Rea et al. 2004) | 4 | Self-management |
Delivery system design | ||||||
Decision support | ||||||
Clinical information system | ||||||
Performance
| n/a | n/a | n/a | n/a | n/a | n/a |
Mortality
| 3 n/s (Farrero et al. 2001; Cockcroft et al. 1987; Littlejohns et al. 1991) | 3 n/s (Monninkhof et al. 2003; Hernamdez et al. 2002) | n/a | 1 n/s (Rea et al. 2004) | n/a | n/a |
Health care use
| n/a | 4 sig (Hermiz et al. 2002; Hernandez et al. 2002; Steinel and Madigan 2003; Haggarty et al. 1991) | 2 sig (Neff et al. 2003; Bourbeau et al. 2003) | n/a | 2 | Self-management |
Delivery system design | ||||||
2 | Delivery system design | |||||
Decision support | ||||||
3 | Self-management | |||||
Delivery system design | ||||||
Decision support | ||||||
Hospitalisation
| 1 sig (Farrero et al. 2001) 3 n/s (Cockcroft et al. 1987; Littlejohns et al. 1991; Weinberger et al. 2002) | 4 sig (Hermiz et al. 2002; Hernandez et al. 2003; Steinel and Madigan 2003; Haggerty et al. 1991) | 2 sig (Bourbeau et al. 2003; Neff et al. 2003) | 2 sig (Barnett 2003; Rea et al. 2004) | 1 | Self-management |
2 | Self-management | |||||
Delivery system design | ||||||
2 | Delivery system design | |||||
Decision support | ||||||
3 | Self-management | |||||
Delivery system design | ||||||
Decision support | ||||||
4 | Self-management | |||||
Delivery system design | ||||||
Decision support | ||||||
Clinical information systems | ||||||
Length of stay
| 3 n/s (Cockcroft et al. 1987; Littlejohns et al. 1991; Farrero et al. 2001) | 2 sig (Hernandez et al. 2002; Steinel and Madigan 2003) | 2 sig (Bourbeau et al. 2003; Neff et al. 2003) | n/a | 2 | Self-management |
Delivery system design | ||||||
2 | Delivery system design | |||||
Decision support | ||||||
3 | Self-management | |||||
Delivery system design | ||||||
Decision support |