Abstract
BackgroundChronic respiratory diseases are a major cause of mortality and morbidity, and represent a high chronic disease burden, which is expected to rise between now and 2020. Care for chronic diseases is increasingly located in community settings for reasons of efficiency and patient preference, though what services should be offered and where is contested. Our aim was to identify the key characteristics of a community-based service for chronic respiratory disease to help inform NHS commissioning decisions.MethodsWe used the Delphi method of consensus development. We derived components from Wagner’s Chronic Care Model (CCM), an evidence-based, multi-dimensional framework for improving chronic illness care. We used the linked Assessment of Chronic Illness Care to derive standards for each component.We established a purposeful panel of experts to form the Delphi group. This was multidisciplinary and included national and international experts in the field, as well as local health professionals involved in the delivery of respiratory services. Consensus was defined in terms of medians and means. Participants were able to propose new components in round one.ResultsTwenty-one experts were invited to participate, and 18 agreed to take part (85.7% response). Sixteen responded to the first round (88.9%), 14 to the second round (77.8%) and 13 to the third round (72.2%). The panel rated twelve of the original fifteen components of the CCM to be a high priority for community-based respiratory care model, with varying levels of consensus. Where consensus was achieved, there was agreement that the component should be delivered to an advanced standard. Four additional components were identified, all of which would be categorised as part of delivery system design.ConclusionsThis consensus development process confirmed the validity of the CCM as a basis for a community-based respiratory care service and identified a small number of additional components. Our approach has the potential to be applied to service redesign for other chronic conditions.
Highlights
Chronic respiratory diseases are a major cause of mortality and morbidity, and represent a high chronic disease burden, which is expected to rise between and 2020
Aim To develop consensus among professionals involved in the care of chronic respiratory diseases on the key characteristics of a community-based respiratory service
Summary of main findings Using a three-round Delphi consensus method, we have identified the key components of a community-based respiratory service and the standard to which they should be delivered
Summary
Chronic respiratory diseases are a major cause of mortality and morbidity, and represent a high chronic disease burden, which is expected to rise between and 2020. The current structure of chronic care, which is derived from models of hospital-based acute care, is in need of reform in order to address the specific care needs of long term illness [1,2] In response to this need, recent reforms to community-based care [3,4], including patient self-care through an Expert Patient Programme [5,6,7], which allows for personalised services and care closer to home. Chronic respiratory diseases represent a considerable burden on health care services. They contribute to social inequalities in life expectancy, notably through preventable early deaths, as well as to excess winter deaths [8]. In the UK, COPD alone accounts for 1.4 million GP consultations per year and 1 in 8 emergency admissions [11], and its prevalence is expected to rise between 2010 and 2020 [8]
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