Improving Asthma Outcomes Through Spirometry Distance Learning

描述(由申请人提供)：肺活量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。当仅根据症状进行评估时，就会出现哮喘严重程度的错误分类。这种错误的分类可能会导致治疗不足、发病率增加以及医疗保健利用率/成本增加。这项研究的目标是测试由华盛顿大学儿童健康研究所互动医疗培训资源(IMTR)小组开发的名为肺活量360的远程学习质量改进计划的有效性。360肺活量测定仪计划旨在通过提高提供者在使用和解释办公室肺活量测定仪方面的知识和自我效能来改善对哮喘儿童的护理。肺活量测定360计划包括：1)《肺活量测定基本原理：肺功能测试基本指南》，这是一个基于计算机的培训计划，教初级保健提供者如何：a)指导患者制作高质量的肺活量测定测试，b)准确解释肺活量测定数据；2)肺活量测定学习实验室：在互动的虚拟教室环境中，以案例为基础的肺活量测定教学指导测试管理人员和讲解员。这些会议由专业临床教师领导，并存档以供将来参考和审查。3)肺活量测定反馈：对供应商的肺活量测定测试课程进行量身定制的分析，每月提供临床专家对临床上进行的肺活量测定测试的个性化反馈报告。为了测试呼吸测量仪360的有效性，我们将在全美50家初级保健儿科诊所进行随机对照试验。25名练习者将接受完整的肺活量360计划。另一组25个匹配的对照实践将从设备供应商那里接受标准的肺活量测量培训。实践层面的护理质量将通过检查肺活量测试阶段的质量和干预与对照实践中适当使用控制剂药物的频率来衡量。患者层面的护理质量将通过检查特定于哮喘的健康相关生活质量、因哮喘加重而计划外就诊的次数、因哮喘而住院的次数以及哮喘护理费用来评估。如果肺活量360计划被证明是改善哮喘儿童医疗保健的有效方法，我们预计它可以在全国医疗保健提供者中广泛传播。 公共卫生相关性：这项研究将是第一项严格测试在哮喘儿童管理中使用肺活量测定法是否真的会改善这些儿童与哮喘相关的结果的研究。建立一系列证据，将高质量的护理过程与期望的护理结果联系起来，是说服初级保健提供者遵循与这些护理过程有关的建议的第一个关键步骤。如果我们建议的干预措施按照国家哮喘教育和预防计划的建议增加提供者对肺活量测定的利用，并导致改善哮喘儿童的医疗保健结果，我们预计可以向医疗保健提供者广泛传播，从而减少国家层面上与哮喘相关的发病率。

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. This misclassification can lead to inadequate treatment, increased morbidity, and increased healthcare utilization/cost. The goal of this study is to test the effectiveness of a distance learning quality improvement program called Spirometry 360 developed by the interactive Medical Training Resources (iMTR) group at the University of Washington Child Health Institute. The Spirometry 360 program aims to improve care for children with asthma by enhancing provider knowledge and self-efficacy related to the use and interpretation of office-based spirometry. The Spirometry 360 program includes: 1) "Spirometry Fundamentals": A basic guide to lung function testing", a computer-based training program that teaches primary care providers how to: a) coach patients to produce high-quality spirometry tests and b) 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: Tailored analysis of providers' spirometry testing sessions offers monthly individualized feedback reports by clinical experts on spirometry tests performed in the clinic. To test the effectiveness of the Spirometry 360, we will conduct a randomized controlled trial in 50 primary care pediatric practices throughout the United State. Twenty-five practices will receive the full Spirometry 360 program. A separate group of 25 matched control practices will receive standard spirometry training from the equipment vendor. Quality of care at the practice level will be measured by examining the quality of spirometry testing sessions and the frequency of appropriate controller medication use in intervention versus control practices. Quality of care at the patient level will be assessed by examining asthma-specific health related quality of life, numbers of unplanned visits for asthma exacerbations, hospitalizations due to asthma, and costs of asthma care. If the Spirometry 360 program proves to be an effective approach to improving healthcare for children with asthma, we anticipate it could be widely disseminated to healthcare providers nationally. PUBLIC HEALTH RELEVANCE: This study will be the first of its kind to rigorously test whether using spirometry in the management of children with asthma actually results in improved asthma-related outcomes for these children. Building a body of evidence that links high quality processes of care to desired outcomes of that care is a first critical step in convincing primary care providers to follow recommendations related to these care processes. If our proposed intervention increases provider utilization of spirometry as recommended by the National Asthma Education and Prevention Program and leads to improved health-care outcomes for children with asthma, we anticipate it could be widely disseminated to health care providers and thus reduce asthma related morbidity on the national level.