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首页> 外文期刊>JMIR Research Protocols >Modern Innovative Solutions to Improve Outcomes in Asthma, Breathlessness, and Chronic Obstructive Pulmonary Disease (MISSION ABC): Protocol for a Mixed-Methods Study
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Modern Innovative Solutions to Improve Outcomes in Asthma, Breathlessness, and Chronic Obstructive Pulmonary Disease (MISSION ABC): Protocol for a Mixed-Methods Study

机译：改善哮喘，呼吸困难和慢性阻塞性肺疾病（MISSION ABC）结果的现代创新解决方案：混合方法研究方案

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Background A high proportion of the costs for respiratory diseases are generated by a relatively small group of patients with severe disease (recognized or unrecognized) or complex problems that include multimorbidity, at-risk behaviors, and socioeconomic disadvantage. These patients often struggle to engage with the structured, proactive, care approaches for chronic disease management advocated for asthma and chronic obstructive pulmonary disease (COPD), resulting in repeated emergency use of both primary and secondary health care. An integrated approach for the management of complex patients, incorporating both specialist and primary care teams’ expertise, may be effective in improving outcomes for such high-risk patients. However, the evidence is mixed, and there is a need for evaluation of models of integrated care in routine “real-world” clinical settings. Objective This mixed-methods protocol examines the implementation of a novel integrated care model for patients with airways disease and undifferentiated breathlessness by using both quantitative and qualitative evaluation of processes, patient and health care professional experiences, and clinical outcomes throughout the clinic cycles. It aims to establish whether Modern Innovative Solutions to Improve Outcomes in Asthma, Breathlessness, and Chronic Obstructive Pulmonary Disease (MISSION ABC), including innovative diagnostic and self-management tools, can deliver improvements in health service use and clinical outcomes for the different patient groups (asthma, breathlessness, and COPD) and compares the 12-month period prior to the first patient visit and the 6-month period following the last visit. Methods A combination of study designs is required to evaluate all aspects of the service: participatory action research approach, involving real-time evaluation at each clinic to inform subsequent clinics; before-and-after study for patient outcomes before and after clinic attendance; and qualitative methods (interviews and focus groups). Results The results will be compiled and published in April 2019. Conclusions Evaluation of the clinic cycles will include consideration of qualitative data from patients, carers, and health care professionals in addition to quantitative outcomes for service implementation and patient factors. The long-term impact of the service will be evaluated using clinical and health service outcomes.
机译：背景技术呼吸系统疾病的费用中，很大一部分是由相对较小的一组患有严重疾病（已识别或未识别）或复杂问题（包括多发病，高危行为和社会经济劣势）的患者产生的。这些患者经常难以采用针对哮喘和慢性阻塞性肺疾病（COPD）提倡的慢性疾病管理的结构化，积极主动的护理方法，导致反复紧急使用初级和二级卫生保健。结合专家和基层医疗团队的专业知识来管理复杂患者的综合方法，可能会有效地改善此类高危患者的预后。但是，证据不一，需要在常规的“现实世界”临床环境中评估综合护理模型。目的该混合方法方案通过对过程，患者和卫生保健专业经验以及整个临床周期的临床结果进行定量和定性评估，研究了针对气道疾病和未分化呼吸困难患者的新型综合护理模型的实施情况。它旨在确定改善哮喘，呼吸困难和慢性阻塞性肺疾病（MISSION ABC）结果的现代创新解决方案（包括创新的诊断和自我管理工具）是否可以改善不同患者群体的卫生服务使用和临床结果（哮喘，呼吸困难和COPD），并比较首次患者就诊前的12个月与最后一次就诊后的6个月。方法需要结合研究设计来评估服务的各个方面：参与式行动研究方法，涉及在每个诊所进行实时评估以告知后续诊所;门诊就诊前后的患者预后研究;和定性方法（访谈和焦点小组）。结果结果将在2019年4月汇总和发布。结论对临床周期的评估将包括考虑患者，护理人员和医疗保健专业人员的定性数据，以及服务实施和患者因素的定量结果。服务的长期影响将使用临床和健康服务结果进行评估。

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