The changing nature of chronic care and coproduction of care between primary care professionals and patients with COPD and their informal caregivers

Figures & data

Table 1 Interventions implemented in the disease management program according to the six dimensions of the chronic care model

Kennemer Lucht COPD management program
Organizational support	Integrated financing
Organizational support	Sustainable financing agreements with health insurers
Community	Cooperation with external community partners
Community	Multidisciplinary and transmural collaboration
Community	Role model in the area
Community	Regional collaboration for spread of the DMP
Community	Regional training course
Self-management	Promotion of disease-specific information
Self-management	Individual care plan
Self-management	Lifestyle interventions (physical activity, diet, quit smoking)
Self-management	Personal coaching
Self-management	Motivational interviewing
Self-management	Informational meetings
Self-management	Diagnosis and treatment of mental health issues
Decision support	Care standards/clinical guidelines
Decision support	Uniform treatment protocol in outpatient and inpatient care
Decision support	Training and independence of practice assistants
Decision support	Professional education and training for care providers
Decision support	Automatic measurement of process/outcome indicators
Decision support	Audit and feedback
Decision support	Periodic evaluation of interventions and goal achievement
Decision support	Structural participation in knowledge exchange
Decision support	Quality of Life questionnaire
Decision support	Measurement of patient satisfaction
Delivery system design	Delegation of care from specialist to nurse/care practitioner
Delivery system design	Systematic follow-up of patients
Delivery system design	Meeting of different disciplines to exchange information
Delivery system design	Monitoring of high-risk patients
Delivery system design	Periodic discussions between professionals (and patients)
ICT	Electronic Patient Records system (without Patient Portal)
ICT	Integrated Chain Information System
ICT	Use of ICT for internal and/or regional benchmarking
ICT	Creation of a safe environment for data exchange
ICT	Systematic registration by every caregiver
ICT	Exchange of information among care disciplines

Notes: Copyright ©2015. Reproduced from Cramm JM, Jolani S, van Buuren S, Nieboer AP. Better experiences with quality of care predict well-being of patients with chronic obstructive pulmonary disease in the Netherlands. Int J Integr Care. 2015;15:e028.³³

Abbreviations: DMP, disease management program; ICT, information and communications technology.

Table 2 Descriptive statistics for 441 patients participating in the Kennemer Lucht COPD management program

Descriptive statistics	Mean ± SD or percentage	Range
Age (years)	69.9±9.7	(actual range 30–93)
Sex (female)	44
Marital status (single)	32
Educational level (low)	36
Perceived quality of chronic care	2.8±0.9	1–5
Relational coproduction with professionals	3.6±1.1	1–5
Frequent communication	3.1±1.1	1–5
Timely communication	3.2±1.3	1–5
Accurate communication	3.5±1.3	1–5
Problem-solving communication	3.9±1.2	1–5
Shared knowledge	3.8±1.2	1–5
Shared respect	4.3±1.0	1–5
Shared knowledge goals	3.9±1.2	1–5

Abbreviation: SD, standard deviation.

Table 3 Relational coproduction between patients and professionals within the Kennemer Lucht COPD management program

Patients’ perceptions of relational coproduction with	Mean ± SD	Range
General practitioner	3.8±1.0	1–5
Specialist	2.9±1.5	1–5
Nurse practitioner	3.7±1.2	1–5
Dietician	1.7±1.3	1–5
Physical therapist	2.4±1.5	1–5

Abbreviation: SD, standard deviation.

Table 4 Descriptive statistics for 62 professionals working in the Kennemer Lucht disease management program

Descriptive statistics	Mean ± SD	Range
Overall perceived quality of chronic care	7.6±1.4	0–11
Organizational support	8.1±2.1	0–11
Community	7.4±2.0	0–11
Self-management	6.9±1.8	0–11
Decision support	7.6±1.5	0–11
Delivery system design	8.6±1.5	0–11
ICT	7.2±1.7	0–11
Perceived productive interaction with patients with COPD	4.2±0.4	1–5
Perceived productive interaction with informal caregivers of patients with COPD	3.3±0.8	1–5

Abbreviations: SD, standard deviation; ICT, information and communications technology.

Table 5 Correlations between quality of chronic care and relational coproduction among professionals (n=62)

Quality of chronic care	Relational coproduction with patients with COPD	Relational coproduction with informal caregivers
Overall perceived quality of chronic care	0.4***	0.4***
Organizational support	0.3*	−0.0
Community	0.3*	0.2
Self-management	0.3**	0.5***
Decision support	0.4**	0.4**
Delivery system design	0.4***	0.4**
ICT	0.2	0.4

Notes:

*** P≤0.001,

** P≤0.01,

* P≤0.05.

Abbreviation: ICT, information and communications technology.

Table 6 Correlations among background characteristics, perceived quality of chronic care, and relational coproduction among patients (n=411)

Background characteristics and quality of chronic care	Relational coproduction
Age (years)	−0.1
Marital status (single)	0.0
Low educational level	0.0
Sex (female)	0.1
Perceived quality of chronic care	0.5***

Note:

*** P≤0.001.

Table 7 Predictors of relational coproduction among patients, determined by multilevel regression analyses (random intercepts model; n=344)

Predictors of relational co-production	β	SE
Constant	1.6***	0.4
Age (years)	0.0	0.0
Marital status (single)	0.0	0.1
Low educational level	−0.0	0.1
Sex (female)	0.1	0.1
Perceived quality of chronic care	0.7***	0.1

Notes:

*** P≤0.001 (two-tailed). List-wise deletion of missing cases.

Abbreviation: SE, standard error.

CrammJMJolaniSvan BuurenSNieboerAPBetter experiences with quality of care predict well-being of patients with chronic obstructive pulmonary disease in the NetherlandsInt J Integr Care201515e02826150766

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