A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study

Abstract

Background In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care. Methods We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program. Results We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. Conclusions This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study’s focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.

Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care

“… 35 In a region of Canada, an IDM known as Best Care COPD has been shown to improve patient outcomes. 36 , 37 In Switzerland it been suggested that advanced practice nurses may also be able to play a key role within a multi-professional team in future models of care to coordinate patient care across sectors. 38 Increased use of telehealth technologies for pulmonary rehabilitation or remote consultations, likely to have been accelerated by the COVID-19 pandemic, are also providing additional options for care models.…”

Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study

“…17 Further evaluative studies of the Best Care COPD Programme supported real-world effectiveness, reporting that Best Care improved patient and provider experiences, and that it was cost-effective and dominant relative to the usual standard of care. [18][19][20][21][22][23] As with the majority of studies forming a large body of published literature on IDM, the quantitative evaluations were limited to 1 year of locally collected follow-up data. 13 Additionally, even for pulmonary rehabilitation, a gold-standard COPD IDM intervention, the long-term impacts are unproven.…”

Designing systems for the care we need: A transformation journey in Southwestern Ontario

“…A critical element of this selection process was consensus and evidence that local assets (notably the Best Care Team) could be leveraged within this sub-population to generate improvement in experiences, outcomes, and total cost of care across the system. 19 , 20 WOHT leveraged ongoing and established work to support this population as a way to make an even greater impact on the equity-driven Quadruple Aim, specifically health outcomes and patient and provider experiences. It was also felt that this sub-population offered a foundation for change that could demonstrate the principles of integrated care and population health management extending beyond traditional medical care.…”