Construction of the Triangle Stratified and Graded Management Process for Chronic Obstructive Pulmonary Disease

Background Hospitalization serves as a critical window for optimizing comprehensive interventions in COPD. However, the clinical management of hospitalized COPD patients in China lacks a systematic integrated program based on disease heterogeneity, leading to the failure of functional rehabilitation efficacy to meet expected goals. The Triangle model has been validated for its effectiveness in the management of common chronic disease patients, which can effectively control disease progression, reduce the incidence of complications, and improve quality of life. Therefore, this study aimed to construct a hierarchical classification management system for COPD inpatients based on the Triangle professional-self-management synergy model, and to achieve the dual goals of accurate medical resource allocation and personalized health service provision. Methods Based on the Triangle Chronic Disease Management Framework and graded care standards, we systematically integrated authoritative guidelines and expert consensus from home and abroad, and adopted the modified Delphi method to complete the construction of the graded management process in three stages. Stage 1-initial framework construction: extract high-frequency management elements through bibliometric analysis (CiteSpace 6.2), and form a draft of the primary process by combining clinical departments (respiratory medicine, intensive care medicine) and expert interviews; Stage 2-expert consultation implementation: select tertiary hospitals in seven representative cities of the country, and conduct two rounds of correspondence consultations with 44 senior experts in five fields, including clinical treatment, specialist care, and health management. Two rounds of correspondence consultation were conducted with 44 senior experts covering five fields, including clinical treatment, specialist care, and health management. In the first round, Likert 5-level scoring method was used to assess the importance of the indicators, and 39 valid questionnaires (88.63%) were recovered; in the second round, the indicator system was adjusted based on the statistical results of the first round (authority coefficient of 0.91, Kendall's W = 0.42), and 42 valid questionnaires (95.45%) were recovered; Stage 3-optimisation of the indicator system: the Coefficient of Variation method (CV < 0.15) and boundary value analysis to finally establish a tiered management scheme containing 6 core dimensions and 59 specific operational indicators. Conclusion Expert authority: the positive coefficients of experts in the two rounds of consultation were 88.63% and 95.45% respectively, with the degree of authority (Cr) reaching 0.91/0.90, and the coefficient of coordination of opinions (Kendall's W) significantly improved (0.42→0.476, P < 0.05); indicator reliability: the coefficients of variation of the finalized second-level indicators were controlled within the range of 0.131–0.132 range, showing a good degree of expert consensus. Results The COPD hierarchical management system established in this study provides a replicable and standardized solution for chronic disease management through the "professional care plus self-management" mechanism, which rationally allocates medical resources and meets the individualized medical needs of different patients.