{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T19:25:46Z","timestamp":1787081146349,"version":"build-2736575974"},"reference-count":44,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Community-based management of exacerbations in high-risk patients with chronic obstructive respiratory diagnoses remains a major challenge. Hybrid care interventions, combining digital support with in-person, patient-centered care, have shown efficacy to reduce unplanned hospitalizations in controlled trials. However, an efficacy-effectiveness gap remains, indicating the complexities of its deployment and sustainable adoption in real-world scenarios.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to co-design the core components of a hybrid care intervention for the preventive management of exacerbations in high-risk patients with chronic obstructive respiratory conditions, generating insights to guide sustainable adoption in routine clinical practice.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Four plan-do-study-act (PDSA) co-design cycles were conducted, using a convergent mixed methods approach, during the 2-year follow-up (2024\u20102025) of a cohort of 205 high-risk patients pertaining to two different clinical programs: (1) the community-based program included multimorbid patients with chronic obstructive pulmonary disease (COPD), asthma, or bronchiectasis from the Integrated Health District of Barcelona-Esquerra (AISBE, 520 k citizens) and (2) the Severe Asthma Program included patients with severe asthma. In all cases, patients were managed following the corresponding disease-specific consensus guidelines. The specific aims of each PDSA cycle were: PDSA-1, patients\u2019 profiling and applicability of technological tools; PDSA-2, definition of clinical aspects of the hybrid care intervention and refinement of technology; PDSA-3, evaluation of a consolidated version of the hybrid care intervention; and PDSA-4, final refinements.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n At the end of PDSA-3 (August 2025), the operationalization of the three core components of hybrid care\u2014(1) nurse-led in-person care, (2) personalization of the intervention, and (3) advanced digital support\u2014was achieved. The main study outcome was established through consensus among all key stakeholders on two aspects: (1) applicability of the hybrid care intervention for management of these patients in clinically stable conditions and during exacerbations in the real-world setting and (2) a well-defined strategy for its short-term deployment and sustainable site adoption.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The intervention rollout requires emphasis on (1) alignment with local care pathways and information systems, (2) clear role definition and escalation procedures across care tiers, and (3) adaptation of the digital layer to patients\u2019 capabilities, including pragmatic support for those with limited digital literacy. The co-design process enabled the operationalization of a hybrid care intervention integrating nurse-led management, personalization of care, and advanced digital support. Stakeholders reached consensus regarding its applicability and implementation strategy. Future real-world implementation studies are needed to evaluate its effects on clinical outcomes, health care use, patient experience, and health care value generation.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/96600","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:55:09Z","timestamp":1783450509000},"page":"e96600-e96600","source":"Crossref","is-referenced-by-count":0,"title":["A Hybrid Care Intervention for High-Risk Patients With Chronic Obstructive Respiratory Disorders: Mixed Methods Co-Design Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6061-1259","authenticated-orcid":false,"given":"Alba","family":"G\u00f3mez-L\u00f3pez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4461-2503","authenticated-orcid":false,"given":"N\u00faria","family":"S\u00e1nchez-Ruano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3794-2845","authenticated-orcid":false,"given":"Marta","family":"Sorribes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7330-9621","authenticated-orcid":false,"given":"Rub\u00e8n","family":"Gonz\u00e1lez-Colom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3073-7126","authenticated-orcid":false,"given":"Marina","family":"Paredes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6740-9471","authenticated-orcid":false,"given":"Jin-Seok","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Jos\u00e9","family":"Gordillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8736-5365","authenticated-orcid":false,"given":"Emili","family":"Vela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5982-7975","authenticated-orcid":false,"given":"Gerard","family":"Carot-Sans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2286-8384","authenticated-orcid":false,"given":"Alba","family":"Jim\u00e9nez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5352-919X","authenticated-orcid":false,"given":"Xabier","family":"Michelena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9084-7824","authenticated-orcid":false,"given":"Ramon","family":"Farr\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4768-8722","authenticated-orcid":false,"given":"Josep","family":"Roca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2938-7459","authenticated-orcid":false,"given":"Isaac","family":"Cano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9170-1782","authenticated-orcid":false,"given":"Alicia","family":"Aguado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7581-7619","authenticated-orcid":false,"given":"Jose","family":"Fermoso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4371-3994","authenticated-orcid":false,"given":"N\u00e9stor","family":"Soler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7749-2838","authenticated-orcid":false,"given":"Ebymar","family":"Arismendi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"issue":"7","key":"R1","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1164\/rccm.202301-0106PP","article-title":"Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary","volume":"207","author":"Agust\u00ed","journal-title":"Am J Respir Crit Care Med"},{"key":"R2","unstructured":"2025 GINA strategy report: global strategy for asthma management and prevention. Global Initiative for Asthma (GINA); 2025. URL: https:\/\/ginasthma.org\/2025-gina-strategy-report\/ [Accessed 30-07-2026]"},{"issue":"3","key":"R3","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00629-2017","article-title":"European Respiratory Society guidelines for the management of adult bronchiectasis","volume":"50","author":"Polverino","journal-title":"Eur Respir J"},{"key":"R4","unstructured":"Chronic respiratory diseases in the WHO European region. World Health Organization. 2025. URL: https:\/\/www.who.int\/europe\/publications\/i\/item\/WHO-EURO-2025-12340-52112-79990 [Accessed 30-07-2026]"},{"issue":"7","key":"R5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-097006","article-title":"Future exacerbations and mortality rates among patients experiencing COPD exacerbations: a meta-analysis of results from the EXACOS\/AVOIDEX programme","volume":"15","author":"Rhodes","journal-title":"BMJ Open"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-13687-5","article-title":"Hospitalizations and inpatient resource consumption of patients suffering from chronic disease - past trend and forecast for Switzerland","volume":"25","author":"Bukanova-Berend","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"R7","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1164\/rccm.202505-1162VP","article-title":"The ROME COPD exacerbation proposal works! Time to move forward","volume":"212","author":"Celli","journal-title":"Am J Respir Crit Care Med"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S344669","article-title":"Disease trajectories and impact of one moderate exacerbation in Gold B COPD patients","volume":"17","author":"L\u00f8kke","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2018.06.014","article-title":"A comprehensive care plan that reduces readmissions after acute exacerbations of COPD","volume":"141","author":"Ohar","journal-title":"Respir Med"},{"issue":"3","key":"R10","doi-asserted-by":"publisher","first-page":"185","DOI":"10.15326\/jcopdf.5.3.2017.0177","article-title":"The effects of a comprehensive care management program on readmission rates after acute exacerbation of COPD at a community-based academic hospital","volume":"5","author":"Euceda","journal-title":"Chronic Obstr Pulm Dis"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1183\/09031936.06.00063205","article-title":"Integrated care prevents hospitalisations for exacerbations in COPD patients","volume":"28","author":"Casas","journal-title":"Eur Respir J"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.2196\/47672","article-title":"A practice-proven adaptive case management approach for innovative health care services (health circuit): cluster randomized clinical pilot and descriptive observational study","volume":"25","author":"Herranz","journal-title":"J Med Internet Res"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","first-page":"15022","DOI":"10.1038\/npjpcrm.2015.22","article-title":"Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial","volume":"25","author":"Hern\u00e1ndez","journal-title":"NPJ Prim Care Resp Med"},{"issue":"7","key":"R14","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1016\/j.apmr.2023.03.005","article-title":"Barriers and facilitators to the adoption of evidence-based interventions for adults within occupational and physical therapy practice settings: a systematic review","volume":"104","author":"Kinney","journal-title":"Arch Phys Med Rehabil"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1637748","article-title":"Digital interventions addressing the unmet needs of older adults with multimorbidity: a mixed-methods persona design approach","volume":"13","author":"De Luca","journal-title":"Front Public Health"},{"key":"R16","unstructured":"Knowledge for improving indoor air quality and health. K-Health in Air. URL: https:\/\/k-healthinair.eu [Accessed 30-07-2026]"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2024-002589","article-title":"Protocol for the enhanced management of multimorbid patients with COPD and severe asthma: role of indoor air quality","volume":"12","author":"G\u00f3mez-L\u00f3pez","journal-title":"BMJ Open Respir Res"},{"issue":"8","key":"R18","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1016\/j.cppeds.2018.08.006","article-title":"Running PDSA cycles","volume":"48","author":"Christoff","journal-title":"Curr Probl Pediatr Adolesc Health Care"},{"issue":"2","key":"R19","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1258\/jhsrp.2007.007074","article-title":"The quality of mixed methods studies in health services research","volume":"13","author":"O\u2019Cathain","journal-title":"J Health Serv Res Policy"},{"issue":"6 Pt 2","key":"R20","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs-principles and practices","volume":"48","author":"Fetters","journal-title":"Health Serv Res"},{"issue":"9","key":"R21","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research: a synthesis of recommendations","volume":"89","author":"O\u2019Brien","journal-title":"Acad Med"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.2196\/58933","article-title":"A 25-year retrospective of health IT infrastructure building: the example of the Catalonia Region","volume":"26","author":"Piera-Jim\u00e9nez","journal-title":"J Med Internet Res"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-026-02395-x","article-title":"Ten-year population-based assessment of multimorbidity burden progression in a regional cohort of 5.5 million adults","volume":"9","author":"Valero-Bover","journal-title":"NPJ Digit Med"},{"issue":"10","key":"R24","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1016\/j.aprim.2016.06.003","article-title":"Adjusted morbidity groups: a new multiple morbidity measurement of use in primary care [Article in Spanish]","volume":"48","author":"Monterde","journal-title":"Aten Primaria"},{"issue":"2","key":"R25","doi-asserted-by":"publisher","DOI":"10.5334\/ijic.7701","article-title":"Toward adoption of health risk assessment in population-based and clinical scenarios: lessons from JADECARE","volume":"24","author":"Gonzalez-Colom","journal-title":"Int J Integr Care"},{"key":"R26","unstructured":"WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). World Health Organization. URL: https:\/\/www.who.int\/standards\/classifications\/international-classification-of-functioning-disability-and-health\/who-disability-assessment-schedule [Accessed 13-06-2025]"},{"key":"R27","unstructured":"The World Health Organization-Five Well-Being Index (WHO-5). World Health Organization. URL: https:\/\/www.who.int\/publications\/m\/item\/WHO-UCN-MSD-MHE-2024.01 [Accessed 13-06-2025]"},{"issue":"7","key":"R28","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1007\/s11136-009-9496-9","article-title":"Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items","volume":"18","author":"Hays","journal-title":"Qual Life Res"},{"issue":"1","key":"R29","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jaci.2003.09.008","article-title":"Development of the asthma control test: a survey for assessing asthma control","volume":"113","author":"Nathan","journal-title":"J Allergy Clin Immunol"},{"issue":"3","key":"R30","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1183\/09031936.00102509","article-title":"Development and first validation of the COPD Assessment Test","volume":"34","author":"Jones","journal-title":"Eur Respir J"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.pcrj.2003.11.004","article-title":"Evaluation of an intervention to improve successful completion of the Mini-AQLQ: comparison of postal and supervised completion","volume":"13","author":"Pinnock","journal-title":"Prim Care Respir J"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1002\/alr.22888","article-title":"The predictive utility of the 22-item sino-nasal outcome test (SNOT-22): a scoping review","volume":"12","author":"Liu","journal-title":"Int Forum Allergy Rhinol"},{"issue":"6","key":"R33","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1164\/arrd.1986.134.5.1129","article-title":"Further specification and evaluation of a new clinical index for dyspnea","volume":"134","author":"Stoller","journal-title":"Am Rev Respir Dis"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1017\/gmh.2016.7","article-title":"The 12-item WHO Disability Assessment Schedule II as an outcome measure for treatment of common mental disorders","volume":"3","author":"Thomas","journal-title":"Glob Ment Health"},{"key":"R35","unstructured":"Gonzalez-Colom R . Predictive modelling for personalised multimorbidity management. University of Barcelona; 2024. URL: https:\/\/hdl.handle.net\/10803\/691632 [Accessed 30-07-2026]"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/40846","article-title":"Prevention of unplanned hospital admissions in multimorbid patients using computational modeling: observational retrospective cohort study","volume":"25","author":"Gonz\u00e1lez-Colom","journal-title":"J Med Internet Res"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00753-2019","article-title":"Technical standards for respiratory oscillometry","volume":"55","author":"King","journal-title":"Eur Respir J"},{"issue":"1","key":"R38","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-89892-3","article-title":"Assessing the clinical reliability of short-term heart rate variability: insights from controlled dual-environment and dual-position measurements","volume":"15","author":"Besson","journal-title":"Sci Rep"},{"issue":"1","key":"R39","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2025-003899","article-title":"Should household air quality monitoring be considered in selected patients with asthma and COPD?","volume":"13","author":"Gonz\u00e1lez-Colom","journal-title":"BMJ Open Respir Res"},{"key":"R40","unstructured":"Gonz\u00e1lez Colom R G\u00f3mez L\u00f3pez A Soler N et al. Oscillometry in chronic respiratory diseases: from standardization to clinical adoption. Zenodo; Jul 23, 2026. [doi: 10.5281\/zenodo.21507624]"},{"issue":"5","key":"R41","doi-asserted-by":"publisher","first-page":"1997","DOI":"10.1111\/hex.13808","article-title":"Towards an Implementation-STakeholder Engagement Model (I-STEM) for improving health and social care services","volume":"26","author":"Potthoff","journal-title":"Health Expect"},{"issue":"1","key":"R42","doi-asserted-by":"publisher","first-page":"48","DOI":"10.21203\/rs.3.rs-3582196\/v1","article-title":"How is tailored implementation undertaken using a self-guided toolkit? Qualitative study of the ItFits-toolkit in the ImpleMentAll project","volume":"19","author":"Finch","journal-title":"Implement Sci"},{"issue":"6","key":"R43","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1001\/jama.2021.25181","article-title":"The quintuple aim for health care improvement: a new imperative to advance health equity","volume":"327","author":"Nundy","journal-title":"JAMA"},{"issue":"3","key":"R44","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1164\/rccm.202406-1254CI","article-title":"Is disease stability an attainable chronic obstructive pulmonary disease treatment goal?","volume":"211","author":"Singh","journal-title":"Am J Respir Crit Care Med"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:44:58Z","timestamp":1787078698000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2026\/1\/e96600"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":44,"URL":"https:\/\/doi.org\/10.2196\/96600","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"v28i7e96600"}}