e-Vita: design of an innovative approach to COPD disease management in primary care through eHealth application

Abstract

BackgroundCOPD is a highly complex disease to manage as patients show great variation in symptoms and limitations in daily life. In the last decade self-management support of COPD has been introduced as an effective method to improve quality and efficiency of care, and to reduce healthcare costs. Despite the urge to change the organisation of health care and the potential of eHealth to support this, large-scale implementation in daily practice remains behind, especially in the Netherlands.Methods/DesignWe designed a multilevel study, called e-Vita, to investigate different organisational implementation methods of a self-management web portal to support and empower patients with COPD in three different primary care settings. Using a parallel cohort design, the clinical effects of the web portal will be assessed using an interrupted times series (ITS) study design and measured according to changes in health status with the Clinical COPD Questionnaire (CCQ). The different implementations and net benefits of self-management through eHealth on clinical outcomes will be evaluated from human, organisational, and technical perspectives.DiscussionTo our knowledge this is the first study to combine different study designs that enable simultaneous investigation of clinical effects, as well as effects of different organisational implementation methods whilst controlling for confounding effects of the organisational characteristics. We hypothesize that an implementation with higher levels of personal assistance, and integrated in an existing care program will result in increased use of and satisfaction with the platform, thereby increasing health status and diminishing exacerbation and hospitalisation.Trial registrationNTR4098 (31-07-2013)

High Level of Integration in Integrated Disease Management Leads to Higher Usage in the e-Vita Study: Self-Management of Chronic Obstructive Pulmonary Disease With Web-Based Platforms in a Parallel Cohort Design

“…Full methodological details were reported previously [31]. Figure 1 presents an overview of the combined study design with organizational and technical differences.…”

The Effect of Integration of Self-Management Web Platforms on Health Status in Chronic Obstructive Pulmonary Disease Management in Primary Care (e-Vita Study): Interrupted Time Series Design

“…The number of patients lost to follow-up (no log on to the platform after signing informed consent or not completing the entire intervention period) was 132; results of the nonparticipation analysis are reported elsewhere [ 33 ]. Figure 3 shows the reasons for loss to follow-up in groups 1 and 2; patients in group 3 were not asked for their reasons.…”

“…Full methodological details of this multilevel parallel cohort design have been reported previously [ 33 ]. For our implementation study in a real-life health care setting, we used an interrupted time series (ITS) design in a pragmatic trial in which data were collected at multiple time points before and after implementation to detect whether the intervention had a significantly greater effect than any underlying secular trend [ 34 ].…”

“…In groups 1 and 2, the first question the nurse asked was what patients would like to achieve in their daily life when they would have a lower burden of disease. With the platform, the patients could work with a coaching program on their personal goals, actions and health-related QoL [ 33 ]. In group 3, the online platform was offered without integration in COPD IDM (None); health care providers and patients received basic instructions on the platform.…”

“…The patients received automated online reminders. Details on the online platforms are published elsewhere [ 33 ].…”