Objectives: To evaluate the implementation of three regional disease-management programmes on chronic obstructive pulmonary disease (COPD) based on bottlenecks experienced in professional practice. Methods: The authors performed a multisite comparison of three Dutch regional diseasemanagement programmes combining patient-related, professional-directed and organisational interventions. Process (Assessing Chronic Illness Care survey) and outcome (disease specific quality of life (clinical COPD questionnaire (CCQ); chronic respiratory questionnaire (CRQ)), Medical Research Council dyspnoea and patients' experiences) data were collected for 370 COPD patients and their care providers. Results: Bottlenecks in region A were mostly related to patient involvement, in region B to organisational issues and in region C to both. Selected interventions related to identified bottlenecks were implemented in all programmes, except for patient-related interventions in programme A. Within programmes, significant improvements were found on dyspnoea and patients' experiences with practice nurses. Outcomes on quality of life differed between programmes: programme A did not show any significant improvements; programme B did show any significant improvements on CCQ total (p<0.001), functional (p=0.011) and symptom (p<0.001), CRQ fatigue (p<0.001) and emotional scales (p<0.001); in programme C, CCQ symptom (p<0.001) improved significantly, whereas CCQ mental score (p<0.001) deteriorated significantly. Regression analyses showed that programmes with better implementation of selected interventions resulted in relatively larger improvements in quality of life (CCQ). Conclusions: Bottom-up implementation of COPD disease-management programmes is a feasible approach, which in multiple settings leads to significant improvements in outcomes of care. Programmes with a better fit between implemented interventions and bottlenecks showed more positive changes in outcomes.

doi.org/10.1136/bmjqs.2010.041236, hdl.handle.net/1765/26033
BMJ Quality and Safety
Erasmus MC: University Medical Center Rotterdam

Lemmens, K.M.M, Nieboer, A.P, Rutten-van Mölken, M.P.M.H, Schayck, O.C.P, Spreeuwenberg, C, Asin, J.D, & Huijsman, R. (2011). Bottom-up implementation of disease-management programmes: Results of a multisite comparison. BMJ Quality and Safety, 20(1), 76–86. doi:10.1136/bmjqs.2010.041236