The Provider and Organization in Asthma Guidelines

描述（由申请人提供）： 不到20%的初级保健提供者遵守国家哮喘指南。 为改善医疗服务提供者遵守准则而采取的干预措施取得了一定的成功。 我们认为，改变供应商的行为必须在供应商的环境的背景下看待。 我们假设，谁是最成功的实施和维持哮喘管理计划的供应商将有一套个人属性，与哮喘有关，其特点是准备改变，高自我效能，积极的结果预期和高结果价值，并将在促进和支持这些活动的组织内工作。 我们提出了两个阶段的研究。 在第1阶段（第1年），将举行调查工具开发和测试以及供应商会议，讨论干预措施。 49个正在使用哮喘管理计划（称为“轻松呼吸”）的诊所/诊所的提供者将完成这些调查，这些调查将描述诊所/诊所的组织和组织文化以及围绕哮喘的提供者个人属性。 在第2-5年，将在其中36家诊所/诊所中进行一项行为干预、组织干预或无干预（对照）的随机对照研究。 行为研究中的诊所/实践将接受干预，包括专家建模、项目、诊所和提供者特定的反馈，以及意见领袖和学术细节的使用。 组织部门的诊所/做法将接受包括基准、领导能力培训和团队建设以及激励/奖励在内的干预措施。 主要结局变量是提供者和诊所/时间单位完成的轻松呼吸调查次数。 我们之前已经证明，通过完成一项调查证明，轻松呼吸（直接改编自国家哮喘指南）的招募是吸入性皮质类固醇使用的替代指标，并与医疗服务利用率下降相关。 因此，本研究将调查供应商的个人属性和组织之间的复杂的相互作用和有针对性的干预措施对供应商的性能，以实施哮喘疾病管理计划的影响。 这些数据将用于未来的研究，以确定如何在成本有限的环境中更好地定制干预措施。

DESCRIPTION (provided by the applicant): Less than 20 percent primary care providers adhere to national asthma guidelines. Interventions to improve provider adherence to guidelines have had modest success. We believe that changing provider behavior must be viewed in the context of the provider's environment. We hypothesize that providers who are most successful in implementing and sustaining asthma management programs will have a set of personal attributes, related to asthma, characterized by readiness to change, high self-efficacy, positive outcome expectancies and high outcome value AND will work within organizations that facilitate and support such activities. We propose a two phase study. In Phase 1 (Year 1) survey instrument development and testing and provider meetings to discuss the interventions will occur. Providers in 49 practices/clinics that are using an asthma management program called Easy Breathing, will complete these surveys that will characterize the organization and organizational culture of the clinics/practices and the provider personal attributes surrounding asthma. In Years 2-5, a randomized, controlled study of either a behavioral intervention, an organizational intervention or no intervention (control) will be performed in 36 of these clinics/practices. Clinics/practices in the behavioral arm will receive an intervention consisting of expert modeling, program-, clinic- and provider-specific feedback, and use of opinion leaders and academic detailing. Clinics/practices in the organizational arm will receive an intervention consisting of benchmarking, leadership capability training and team building and incentives/ rewards. The primary outcome variable is the number of Easy Breathing surveys completed by provider and by clinic/unit of time. We have previously shown that enrollment in Easy Breathing (which was adapted directly from the national asthma guidelines) as demonstrated by completion of a survey is a surrogate indicator of inhaled corticosteroid use and is associated with decreased medical services utilization. This study will thus investigate the complex interactions between provider personal attributes and the organization and the effect of targeted interventions on provider performance to implement an asthma disease management program. These data will then be used in future studies to determine how to better tailor interventions in a cost constrained environment.