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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

Modern innovative solutions to improve outcomes in asthma, breathlessness, and chronic obstructive pulmonary disease (MISSION ABC): protocol for a mixed-methods study
Modern innovative solutions to improve outcomes in asthma, breathlessness, and chronic obstructive pulmonary disease (MISSION ABC): protocol for a mixed-methods study
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.
asthma, breathlessness, COPD, diagnosis, integration, participatory action research
1929-0748
Lanning, Eleanor
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Heiden, Emily
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Longstaff, Jayne
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Fogg, Carole
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Brown, Thomas
cd6e07e9-49fa-4a1a-8b14-d46c206e2724
Rupani, Hitasha
cbc7068a-4279-4c8e-b83f-353210711062
Dewey, Ann
e0734bf3-5ad8-4c6b-8658-089a3b7d36d2
Neville, Daniel
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Jones, Thomas
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DeVos, Ruth
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Mottershaw, Mark
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Bassett, Paul
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Chauhan, Anoop J.
5063e659-a5cd-4a12-86cf-02e9a769fd02
Lanning, Eleanor
c73824db-b97c-457f-93a2-2bebaab8484a
Heiden, Emily
2921110b-b184-4e61-8633-116b1b8129cc
Longstaff, Jayne
04188cf1-96bc-4b51-bce5-aa289ed034c4
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Brown, Thomas
cd6e07e9-49fa-4a1a-8b14-d46c206e2724
Rupani, Hitasha
cbc7068a-4279-4c8e-b83f-353210711062
Dewey, Ann
e0734bf3-5ad8-4c6b-8658-089a3b7d36d2
Neville, Daniel
6f80666d-2af9-4a10-8247-0fd88e3d9b3c
Jones, Thomas
2ed43a38-d65d-4786-9208-a1e1298ce413
DeVos, Ruth
18b46237-2ece-41e6-859f-458bd2a5cb42
Mottershaw, Mark
7a8dd90d-9551-439e-91ae-27ea4fe5b41b
Bassett, Paul
8a7d46b8-f20c-419d-b3aa-f1d8af853da5
Chauhan, Anoop J.
5063e659-a5cd-4a12-86cf-02e9a769fd02

Lanning, Eleanor, Heiden, Emily, Longstaff, Jayne, Fogg, Carole, Brown, Thomas, Rupani, Hitasha, Dewey, Ann, Neville, Daniel, Jones, Thomas, DeVos, Ruth, Mottershaw, Mark, Bassett, Paul and Chauhan, Anoop J. (2019) Modern innovative solutions to improve outcomes in asthma, breathlessness, and chronic obstructive pulmonary disease (MISSION ABC): protocol for a mixed-methods study. Journal of Medical Internet Research (JMIR) Research Protocols, 8 (3), [e9228]. (doi:10.2196/resprot.9228).

Record type: Article

Abstract

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.

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Accepted/In Press date: 23 February 2018
Published date: 18 March 2019
Keywords: asthma, breathlessness, COPD, diagnosis, integration, participatory action research

Identifiers

Local EPrints ID: 437106
URI: http://eprints.soton.ac.uk/id/eprint/437106
ISSN: 1929-0748
PURE UUID: 5a218934-02c7-4926-b238-27275e8eebb8
ORCID for Carole Fogg: ORCID iD orcid.org/0000-0002-3000-6185

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Date deposited: 17 Jan 2020 17:32
Last modified: 23 May 2020 00:46

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