Learning from a Distance: Effectiveness of Online Spirometry Training in Improving Asthma Care
Learning from a Distance: Effectiveness of Online Spirometry Training in Improving Asthma Care
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DOI：
10.1016/j.acap.2011.11.006
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发表时间：
2012-03-01
影响因子：
3.1
通讯作者：
Mangione-Smith, Rita
中科院分区：
文献类型：
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作者：
Stout, James W.;Smith, Karen;Mangione-Smith, Rita
目的：我们评估了旨在改善哮喘儿童初级保健管理的虚拟交付质量改进(QI)计划的有效性。方法：来自14个初级保健儿科诊所(7对配对)的36名医生、护士和医疗助理参加了从2007年10月到2008年9月的整群随机试验。所有的做法都接受了肺活量计和标准供应商培训。在研究期间提供的为期7个月的QI计划包括：i)肺活量测定基本原理(TM)CD-ROM，多媒体教程；2)由临床专家主持的基于病例的交互式网络研讨会；以及3)基于互联网的肺活量测定质量反馈报告系统。练习对直接相互比较，并使用混合效应回归模型分析组间差异。我们的主要观察指标是肺活量测试的频率、质量可接受的肺活量测试的百分比、哮喘严重程度记录和适当的控制药物处方。结果：参与实践总共上传了1028次肺活量测试，其中340次(33.1%)质量可接受。在7个月的干预期内，干预措施和对照措施在进行肺活量测试的频率上没有差别。在基准期内对质量进行调整后，干预措施与匹配的对照措施相比，估计有更大的几率进行质量可接受的测试(优势比2.85；95%可信区间1.78-4.56，P<；.001)。干预提供者在干预期间记录哮喘严重程度的几率也明显更高(优势比2.9，95%可信区间1.8-4.5；P<；.001)。虽然在两组持续性哮喘患者中使用对照药物的比例接近100%，但在干预措施中，被标记为持续性哮喘患者的比例从43%增加到62%，而在对照组(NS)中从57%下降到50%。结论：多方面的距离QI计划导致了呼吸测量质量的提高和哮喘严重程度的改善评估。成功参与QI计划可以远距离进行。
OBJECTIVE: We evaluated the effectiveness of a virtually delivered quality improvement (QI) program designed to improve primary care management for children with asthma.METHODS: Thirty-six physicians, nurses, and medical assistants from 14 primary care pediatric practices (7 matched practice pairs) participated in a cluster randomized trial from October 2007 to September 2008. All practices received a spirometer and standard vendor training. A 7-month QI program delivered during the study period included: I) Spirometry Fundamentals (TM) CD-ROM, a multimedia tutorial; 2) case-based, interactive webinars led by clinical experts; and 3) an internet-based spirometry quality feedback reporting system. Practice pairs were compared directly to each other, and between-group differences were analyzed with the use of mixed effects regression models. Our main outcome measures were the frequency of spirometry testing, percentage of acceptable quality spirometry tests, asthma severity documentation, and appropriate controller medication prescribing.RESULTS: Participating practices uploaded a total of 1028 spirometry testing sessions, of which 340 (33.1%) were of acceptable quality. During the 7-month intervention period, there was no difference between intervention and control practices in the frequency of spirometry tests performed. Intervention practices were estimated to have significantly greater odds of conducting tests with acceptable quality compared with matched control practices, adjusting for quality in the baseline period (odds ratio 2.85; 95% confidence interval 1.78-4.56, P < .001). Intervention providers also had significantly greater odds of documenting asthma severity during the intervention period (odds ratio 2.9, 95% confidence interval 1.8-4.5; P < .001). Although use of controller medications among patients with Persistent asthma approached 100% for both groups, the proportion of asthma patients labeled as persistent increased from 43% to 62% among intervention practices, and decreased from 57% to 50% among controls (NS).CONCLUSIONS: A multifaceted distance QI program resulted in increased spirometry quality and improved assessment of asthma severity levels. Successful participation in QI programs can occur over distance.