Predicting Success in Implementing a Distance QI Intervention for Asthma

描述（由申请人提供）：肺功能测定是初级保健环境中哮喘诊断和治疗的推荐组成部分，但很少有提供者报告其在哮喘儿童中的常规使用。当评估仅基于症状时，会发生哮喘严重程度的错误分类，并可能导致治疗不足，发病率增加和医疗保健利用/成本增加。华盛顿大学的交互式医学培训资源（iMTR）小组开发了一个在线培训计划，称为肺活量测定360。这种质量改进干预（QII）是一个以办公室为基础的计划，旨在通过提高提供者与肺量测定的使用和解释相关的知识和自我效能来改善哮喘患者的呼吸护理。Spirometry 360计划包括： 1)“肺功能测定基本原理（tm）：肺功能测试基本指南”，这是一个基于计算机的培训程序，教授初级保健提供者如何指导患者进行高质量的肺功能测定测试并准确解释肺功能测定数据; 2)肺活量测定学习实验室：基于案例的肺量测定教学在实践中指导测试管理员和口译员通过互动的虚拟教室设置的临床例子。这些会议由专家临床教师领导，并存档供未来参考和审查; 3)肺功能测定反馈：个性化分析供应商的肺功能测定曲线，每月提供 临床专家对在诊所进行的肺量测定测试的个性化反馈报告。 本研究的目的是更好地了解成功实施的实践水平的预测因素， 暴露于Spirometry 360后，在初级护理环境中进行肺功能测定。使用定性方法与样本的14个儿科实践已经暴露于肺活量360计划，我们将开发一个预测工具，称为质量改进干预实施成功量表（QII-ISS）。在实施肺活量测定360之前，将在第二个样本50个实践中测试QII-ISS，以检查其预测肺活量测定成功整合到初级保健环境中儿科哮喘患者管理中的有效性。通过这项研究，我们可以确定在实践层面的可修改的因素，如果改变，可以提高实践的成功与QII的实施一般。这反过来又可以提高儿童在初级保健环境中得到的护理质量。

DESCRIPTION (provided by applicant): Spirometry is a recommended component of asthma diagnosis and treatment in the primary care setting, yet few providers report its routine use for children with asthma. Misclassification of asthma severity occurs when assessment is based on symptoms alone and can lead to inadequate treatment, increased morbidity, and increased healthcare utilization/cost. The Interactive Medical Training Resources (iMTR) group at the University of Washington has developed an online training program, called Spirometry 360. This quality improvement intervention (QII) is an office-based program that aims to improve respiratory care for asthmatics by enhancing provider knowledge and self-efficacy related to the use and interpretation of spirometry. The Spirometry 360 program includes: 1) "Spirometry Fundamentals(tm): A basic guide to lung function testing", a computer-based training program that teaches primary care providers how to coach patients to produce high-quality spirometry tests and accurately interpret spirometric data; 2) Spirometry Learning Lab: Case-based teaching of spirometry in practice guides test administrators and interpreters through clinical examples in an interactive virtual classroom setting. These sessions are led by expert clinical faculty and are archived for future reference and review; 3) Spirometry Feedback: Personalized analysis of providers' spirometry curves offers monthly Individualized feedback reports by clinical experts on spirometry tests performed in the clinic. The goal of this study is to better understand practice-level predictors of successful implementation of spirometry in the primary care setting after exposure to the Spirometry 360. Using qualitative methods with a sample of 14 pediatric practices already exposed to the Spirometry 360 program, we will develop a prediction tool called the Quality Improvement Intervention Implementation Success Scale (QII-ISS). The QII-ISS will be tested in a second sample of 50 practices prior to Spirometry 360 implementation to examine its validity for predicting successful integration of spirometry into the management of pediatric asthma patients in the primary care setting. Through this study, we may identify modifiable factors at the practice level that, if changed, could enhance a practice's success with QII implementation in general. This in turn may improve the quality of care children receive in the primary care setting.