| Sumario: | Purpose: Pulmonary rehabilitation (PR) adherence in patients with chronic obstructive pulmonary disease (COPD) declines markedly after hospital discharge, underscoring the need for theory-driven, continuous care models. The 4C nursing model—integrating Comprehensiveness, Collaboration, Coordination, and Continuity—provides a structured, patient-centered framework that may simultaneously address multiple adherence barriers when delivered via internet-based platforms. This study evaluated the effectiveness of this integrated approach for COPD pulmonary rehabilitation. Patients and Methods: A quasi-experimental study was conducted at Baoding Rehabilitation Hospital (January–December 2024). Ninety-four patients with COPD (GOLD stages II–III) were allocated sequentially to a control group (n = 47; conventional nursing care) or an intervention group (n = 47; internet-based 4C nursing model). Primary outcomes were COPD knowledge scores and PR adherence; secondary outcomes included the COPD Self-Efficacy Scale (CSES), FEV1% predicted, and the COPD Assessment Test (CAT). Outcomes were assessed at baseline, 3 months, and 6 months. Results: Baseline characteristics were comparable between groups (all P > 0.05). At 6 months, the intervention group showed significantly greater improvements in COPD knowledge (mean difference 8.55; 95% CI 7.27– 9.83; Cohen's d = 2.70), self-efficacy (mean difference 15.48; 95% CI 12.25– 18.71; d = 1.94), and PR adherence (mean difference 0.74; 95% CI 0.50– 0.97; d = 1.27), alongside significant improvements in FEV1% predicted (P = 0.005; d = 0.77) and CAT scores (P < 0.001; d = 1.39). Conclusion: This single-center quasi-experimental study found that an internet-based 4C nursing model was associated with clinically meaningful improvements across multiple COPD outcomes over 6 months. These preliminary findings support the feasibility of theory-driven, telehealth-enhanced nursing care and warrant confirmation through multicenter randomized trials.
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