Evaluation of a regional disease management programme for patients with asthma or chronic obstructive pulmonary disease

摘要

Objectives. To assess the impact of a population-based disease management programme for adult patients with asthma or chronic obstructive pulmonary disease (COPD) on process measures, intermediate outcomes, and endpoints of care. Design. Quasi-experimental design with 12-month follow-up. Setting. Region of Maastricht (the Netherlands) including university hospital and 16 general practices. Participants. Nine hundred and seventy-five patients of whom 658 have asthma and 317 COPD. Intervention. Disease management programme. Main outcome measure(s). Endpoints of care are respiratory health, health utility, patient satisfaction, and total health care costs related to asthma or COPD. Results. Quality aspects of care, disease control, self-care behaviour, smoking status, disease-specific knowledge, and patients' satisfaction improved after implementation of the programme. Lung function was not affected by implementation of the programme. For COPD patients, a significant improvement in health utility was found. For patients with asthma, significant cost savings were measured. Conclusions. Organizing health care according to principles of disease management for adults with asthma or COPD is associated with significant improvements in several processes and outcomes of care, while costs of care do not exceed the existing budget.