Protocol for the Enhanced Management of Multimorbid Patients with Chronic Pulmonary Diseases: Role of Indoor Air Quality
Authors: Gómez-López Alba , Arismendi Ebymar , Cano Isaac , Farré Ramón , Fígols María , Hernández Carme , Montilla-Ibarra Antonio , Sánchez-Ruano Núria , Sánchez Benigno , Sisó-Almirall Antoni , Sorribes Marta , Vela Emili , Piera-Jiménez Jordi , Benavent Jaume , Fermoso Jose , Roca Josep , González-Colom Rubèn 
Published: May 2024

ABSTRACTIntroductionReducing unplanned hospital admissions in chronic patients at risk is a key area for action due to the high healthcare and societal burden of the phenomenon. The inconclusive results of preventive strategies in patients with chronic respiratory disorders and comorbidities are explainable by multifactorial but actionable factors.The current protocol (January 2024 to December 2025) relies on the hypothesis that intertwined actions in four dimensions: i) management change, ii) personalisation of the interventions based on early detection/treatment of acute episodes and enhanced management of comorbidities, iii) mature digital support, and iv) comprehensive assessment, can effectively overcome most of the limitations shown by previous preventive strategies. Accordingly, the main objective is to implement a novel integrated care preventive service for enhanced management of these patients, as well as to evaluate its potential for value generation.Methods and analysisAt the end of 2024, the specifics of the novel service will be defined through the articulation of its four main components: i) Enhanced lung function testing through oscillometry, ii) Continuous monitoring of indoor air quality as a potential triggering factor, iii) Digital support with an adaptive case management approach, and iv) Predictive modelling for early identification and management of exacerbations. During 2025, the novel service will be assessed using a Quintuple Aim approach. Moreover, the Consolidated Framework for Implementation Research will be applied to assess the implementation. The service components will be articulated through four sequential six-months Plan-Do-Study-Act cycles. Each cycle involves a targeted co-creation process following a mixed-methods approach with the active participation of patients, health professionals, managers, and digital experts.Ethics and disseminationThe Ethics Committee for Human Research at Hospital Clinic de Barcelona approved the protocol on June 29, 2023 (HCB/2023/0126). Before any procedure, all patients in the study must sign an informed consent form.RegistrationNCT06421402.STRENGTHS AND LIMITATIONSThe articulation of the four service components, identified in a previous co-creation process, ensures a comprehensive approach to the novel integrated care service.Innovative features of the digital support to the service provided by the Health Circuit platform, based on an Adaptive Case Management orientation, should contribute to overcoming current limitations in digital health transformation.Using a Plan-Do-Study-Act strategy, with targeted objectives for each co-creation cycle, will ensure the maturity of the service design and evaluation processes throughout the protocol’s execution.The comprehensive evaluation of the novel service, including a Quintuple Aim approach and assessment of the deployment process using the Consolidated Framework for Implementation Research, will contribute to overcoming the efficacy-effectiveness gap seen in this type of integrated care service.A potential constraint is that only some patients within the cohort may qualify as future candidates for the innovative service in an actual working environment. Nonetheless, the established protocol is designed to effectively discern and identify the specific patient profiles who stand to derive notable benefits from these interventions.