Abstract
BackgroundFavorable effects of formal pulmonary rehabilitation in selected moderate to severe COPD patients are well established. Few data are available on the effects and costs of integrated disease management (IDM) programs on quality of care and health status of COPD patients in primary care, representing a much larger group of COPD patients. Therefore, the RECODE trial assesses the long-term clinical and cost-effectiveness of IDM in primary care.Methods/designRECODE is a cluster randomized trial with two years of follow-up, during which 40 clusters of primary care teams (including 1086 COPD patients) are randomized to IDM or usual care. The intervention started with a 2-day multidisciplinary course in which healthcare providers are trained as a team in essential components of effective COPD IDM in primary care. During the course, the team redesigns the care process and defines responsibilities of different caregivers. They are trained in how to use feedback on process and outcome data to guide implement guideline-driven integrated healthcare. Practice-tailored feedback reports are provided at baseline, and at 6 and 12 months. The team learns the details of an ICT program that supports recording of process and outcome measures. Afterwards, the team designs a time-contingent individual practice plan, agreeing on steps to be taken in order to integrate a COPD IDM program into daily practice. After 6 and 12 months, there is a refresher course for all teams simultaneously to enable them to learn from each other’s experience. Health status of patients at 12 months is the primary outcome, measured by the Clinical COPD Questionnaire (CCQ). Secondary outcomes include effects on quality of care, disease-specific and generic health-related quality of life, COPD exacerbations, dyspnea, costs of healthcare utilization, and productivity loss.DiscussionThis article presents the protocol and baseline results of the RECODE trial. This study will allow to evaluate whether IDM implemented in primary care can positively influence quality of life and quality of care in mild to moderate COPD patients, thereby making the benefits of multidisciplinary rehabilitation applicable to a substantial part of the COPD population.Trial registrationNetherlands Trial Register (NTR): NTR2268
Highlights
Favorable effects of formal pulmonary rehabilitation in selected moderate to severe Chronic obstructive pulmonary disease (COPD) patients are well established
We previously argued that when components of pulmonary rehabilitation (PR) are integrated into a primary care integrated disease management (IDM) program, patients can be treated in their home environment
Based on an earlier controlled clinical trial evaluating the effect of an IDM program in mild to moderate COPD, we found the greatest improvements on quality of life in patients with an Medical Research Counsil (MRC) dyspnea score >2 [25]
Summary
Favorable effects of formal pulmonary rehabilitation in selected moderate to severe COPD patients are well established. Few data are available on the effects and costs of integrated disease management (IDM) programs on quality of care and health status of COPD patients in primary care, representing a much larger group of COPD patients. Optimal care of COPD patients requires an individualized, patient-centered approach that recognizes and treats all aspects of the disease, addresses the systemic effects and co-morbidities, and integrates medical care among healthcare professionals and across healthcare sectors [5]. Hospital admissions and loss of work contribute to the economic burden of disease worldwide, there is much interest in systematically improving the quality of care, while reducing total costs for patients with COPD and other chronic illness. Integrated Disease Management (IDM) programs have proliferated as a means of improving the quality and efficiency of care [6]
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