Respiratory Service Configuration

Background

There is uncertainty as to the ideal model for community based chronic care. This is becoming an important question as the North Tees Momentum programme gathers pace.

The proposal is that the key characteristics of an ideal service are established and described, in order that the commissioners can then make an objective assessment of each service.  We propose to use Wagner's chronic care model as the theoretical underpinning of the exercise and respiratory diease as the clinical. Example, since two differing services are currently commissioned by the PCT

Methods

We will develop a Delphi survey based on components of the chronic care model identified within the literature review.  A purposive sample of experts, including respiratory specialists, community nurses and GPs, will be identified and invited to participate in the study.  They will be provided with evidence based literature for consultation and will be asked to complete 2 rounds of the Delphi survey.    The first round will primarily involve ranking and weighting prepared items, but will also allow for independent generation of ideas.  The second round will provide experts with feedback in the form of their original individual responses as well as a statistical summary of the group's responses.  This will provide the opportunity to revise original judgments and facilitate convergence of group opinion. 

The extent of consensus on individual components and their weightings will be aggregated statistically.    This information will be used to develop a model incorporating the agreed weighted components of an "ideal" service, against which existing services can be evaluated. 

Inclusion criteria for participant selection will be explicitly defined and adequate information will be provided to allow evaluation of the credibility of the panel.  We are expecting to recruit between 15 and 25 experts to the panel. 

Timescale

March to October 2010

Contact e.j.henderson@durham.ac.uk