Open Access Highly Accessed Research article

Application of a theoretical model to evaluate COPD disease management

Karin MM Lemmens1*, Anna P Nieboer1, Maureen PMH Rutten-Van Mölken12, Constant P van Schayck3, Javier D Asin4, Jos AM Dirven5 and Robbert Huijsman1

Author Affiliations

1 Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands

2 Erasmus University Rotterdam, Institute for Medical Technology Assessment (iMTA), Rotterdam, the Netherlands

3 Department of General Practice, Maastricht University, Research Institute CAPHRI, Maastricht, the Netherlands

4 ACSION, Advance Care Solutions and Insights for Optimization, Amstelveen, the Netherlands

5 CAHAG, General Practitioners' Advisory Group for COPD and Asthma, Utrecht, the Netherlands

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BMC Health Services Research 2010, 10:81  doi:10.1186/1472-6963-10-81

Published: 26 March 2010



Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting.


A quasi-experimental research was performed with 12-months follow-up of 189 COPD patients in primary care in the Netherlands. The programme included patient education, protocolised assessment and treatment of COPD, structural follow-up and coordination by practice nurses at 3, 6 and 12 months. Data on intermediate outcomes (knowledge, psychosocial mediators, self-efficacy and behaviour) and final outcomes (dyspnoea, quality of life, measured by the CRQ and CCQ, and patient experiences) were obtained from questionnaires and electronic registries.


Implementation of the programme was associated with significant improvements in dyspnoea (p < 0.001) and patient experiences (p < 0.001). No significant improvement was found in mean quality of life scores. Improvements were found in several intermediate outcomes, including investment beliefs (p < 0.05), disease-specific knowledge (p < 0.01; p < 0.001) and medication compliance (p < 0.01). Overall, process improvement was established. The model showed associations between significantly improved intermediate outcomes and improvements in quality of life and dyspnoea.


The application of a theory-driven model enhances the design and evaluation of disease management programmes aimed at improving health outcomes. This study supports the notion that a theoretical approach strengthens the evaluation designs of complex interventions. Moreover, it provides prudent evidence that the implementation of COPD disease management programmes can positively influence outcomes of care.