Evaluating COPD Disease Management: Application of a Theoretical Model

1. Evaluating COPD Disease Management: Application of a Theoretical Model Karin Lemmens, MSc Dr. Anna Nieboer, Dr. Maureen Rutten-Van M�lken, Prof. Dr. Onno van Schayck, Javier Asin, MD, Jos Dirven, MD and Prof. Dr. Robbert Huijsman

2. Context: Why disease management? (I) The current health care organisation Care is fragmented and duplicated A lack of coordination en continuity of care The current health care system is organised around acute care needs A need for effective and efficient care Little use of management instruments and information technology

3. Context: Why disease management? (II) Strategies to improve care have emerged: Disease Management, including: Care coordination Prevention, pro active patient management and �outreach� Increasing patient involvement More interest for quality of life and other patient oriented outcome Evidence-based medicine Attention for effective and efficient care However, what are the effects of the implementation of a disease programme on process, intermediate and final outcome indicators?

4. Aim To methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting. Use of a theoretical framework Disease management programmes consiting of three main features: 1) patient-related intervention 2) professional-directed intervention 3) organisational intervention Chronic population: COPD

5. Evaluation Model