Effectiveness of nurse-led disease management programs on health outcomes and health service utilization in adult patients with chronic obstructive pulmonary disease: A systematic review protocol

Abstract

Review question/objective The overall objectives of this review are i) to determine the effects of nurse-led Chronic Obstructive Pulmonary Disease (COPD) management programs on patients’ health outcomes and health service utilization; and ii) identify the framework (i.e. structure/ process) of the nurse-led COPD management programs (DMP) which is most effective in improving patient outcomes and health service utilization. Inclusion criteria Types of participants The review will consider studies that include adults with a diagnosis of COPD, who are over 18 years old. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 31 and the American Thoracic/European Respiratory Society Guidelines (ATS/ERS) 32 , the description of the severity of disease is as follows: Airflow obstruction is measured as a reduced FEV 1 /FVC (FVC: Forced vital capacity) ratio (< 0.7) with stage I or mild disease as an FEV 1 of ≥ 80% predicted; stage II or moderate disease as an FEV 1 of 50-79% predicted; stage III or severe as an FEV 1 of 30-49% predicted and stage IV or very severe as an FEV 1 <30% predicted. COPD includes patients with chronic bronchitis and emphysema but not asthma. Types of intervention(s) The review will consider nurse-led COPD disease management programs, as defined according to the Care Continuum Alliance. 15 which implies that disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. 15 The nurse-led DMPs may be delivered by home visit, clinic visit, or tele care and can be delivered either in community-based settings or hospital/medical settings or combined settings. Nurse-led DMPs will be compared with usual care, with “usual care” referring to a wide range of general / routine care options offered in the study settings such as hospitals and out-patient clinics. The structure, process and outcome of the nurse-led COPD management programs will be presented in a narrative report to give an overview of the effectiveness the programs. Types of outcomes The outcomes to be considered in this review are: Self-reported measures of exercise-related dyspnoea Standardized lung function tests Exercise capacity as assessed TRUNCATED AT 350 WORDS