Improving Physician Adherence to Asthma Guidelines

描述(由申请人提供) 格雷戈里·迪埃特，医学博士，硕士，医学和医学助理教授 约翰霍普金斯大学的流行病学。他致力于他的职业生涯 临床研究，重点是衡量和改善结果和 哮喘患者的护理质量。他是一名肺科医生，患有 致力于哮喘的临床实践，他已经赢得了一位大师？S 流行病学学士学位。在拟议的学习期间，职业发展 活动将包括一对一指导、教学工作、相关临床 研究项目的工作、开发和实施、研究报告 研究成果，并学习教授研究技能。 罗伯特·A·怀斯医学博士将担任迪特？S博士的主要导师 共同导师，乔纳森·萨梅特博士、艾伯特·吴和哈亚·鲁宾。马克·刘博士将 与Diette医生在哮喘诊所直接合作，继续他的临床工作 辅导。 该研究项目将集中展示一种新的方法来 组织护理以改善慢性病的护理和预后： 哮喘。哮喘是一种常见的呼吸道疾病，大约有5%的人会受到影响 每年耗资60亿美元。有有效的 药物和治疗策略，以及系统的哮喘护理方法 已通过召开的专家小组制定的指南进行推荐 由国家心肺血液研究所提供。然而，哮喘正在成为 更常见，发病率、死亡率和成本都在上升。 研究表明，哮喘治疗往往与指导方针不一致。 医生不遵守医嘱的理论原因包括缺乏认识和 对指导方针缺乏共识，执行这些指导方针的能力有限。 对指南的遵守也因医生专业而异。虽然 全科医生提供了大部分哮喘治疗，专家通常 提供更符合指导方针的护理。潜在的原因 由专家提供更好的护理包括更多的培训和经验，以及 以更少的障碍为给定的高质量护理提供实践环境 生病了。提供商行为决定因素的综合模型可以帮助 确定遵守的这些障碍，并可用于指导干预 改进实践的策略。 拟议项目的具体目标是： 1.使用定制的评估方法来评估医生的障碍 坚持国家哮喘指南。 2.发展全科医生经营的哮喘诊所，纳入 克服目标1中确定的障碍并改进的干预措施 供应商遵守哮喘指南。 3.确定遵守哮喘指南和结果是否会改善 在全科医生经营的哮喘专科诊所中，与在 普通内科诊所。 该项目的第一阶段是对现有的 在中国的医疗诊所，医生遵守哮喘指南的障碍 马里兰州巴尔的摩市中心。营造门槛更少的执业环境 为了坚持指导方针，我们将开发一家新的全科医生经营的哮喘诊所。 旨在克服研究地点确定的特定障碍。 第二阶段是一项涉及560名成人哮喘患者的临床试验，在这项试验中，他们 医生将被指派在新的哮喘诊所提供哮喘护理 而不是他们通常的普通医疗诊所。我们将衡量遵守情况的变化 分配到新诊所的患者之间的指导方针和结果 那些在普通医疗护理中看到的。这项研究有可能 演示：1)指南的遵从性可以通过 克服指南障碍的现场多因素干预 实施情况；2)保健过程和结果方面的差异 改善了多面手的执业环境，而不是通常的多面手护理； 3)如何组织对慢性病的管理。

DESCRIPTION (provided by applicant) Gregory Diette, M.D., M.H.S. is Assistant Professor of Medicine and Epidemiology at Johns Hopkins University. He is committed to a career in clinical investigation, with a focus on measuring and improving outcomes and quality of care for patients with asthma. He is a pulmonologist with a clinical practice devoted to asthma, and he has already earned a Master?s degree in Epidemiology. During the proposed study period, career development activities will include one-on-one mentoring, didactic work, relevant clinical work, development and conduct of a research project, presentation of research findings, and learning to teach research skills. Robert A. Wise, M.D. will serve as Dr. Diette?s primary mentor along with co-mentors, Drs. Jonathan Samet, Albert Wu, and Haya Rubin. Dr. Mark Liu will work directly with Dr. Diette in asthma clinic to continue his clinical mentoring. The research project will focus on demonstrating a novel approach to organization of care to improve care and outcomes for a chronic illness: asthma. Asthma is a common respiratory condition that affects approximately 5% of the U.S. population at an annual cost of $6 billion. There are effective medications and treatment strategies, and a systematic approach to asthma care has been recommended through guidelines developed by an expert panel convened by the National Heart, Lung and Blood Institute. However, asthma is becoming more common, and the morbidity, mortality and costs are rising. Research suggests that asthma care is often inconsistent with guidelines. Theoretical reasons for physician non-adherence include lack of awareness and lack of agreement with the guidelines, and limited ability to implement them. Adherence to guidelines also varies by physician specialty. Although generalist physicians provide the majority of asthma care, specialists often provide care that is more consistent with guidelines. Potential reasons for better care by specialists include greater training and experience, and also a practice environment with fewer barriers to high quality care for a given illness. A comprehensive model of determinants of provider behavior can help identify these barriers to adherence and can be used to direct intervention strategies to improve practice. The specific aims of the proposed project are: 1. To use a customized, assessment method to assess barriers to physician adherence to national asthma guidelines. 2. To develop a generalist physician-run asthma clinic that incorporates interventions to overcome barriers identified in Aim 1 and to improve provider adherence to asthma guidelines. 3. To determine whether adherence to asthma guidelines and outcomes improve in a generalist-run asthma-specific clinic, compared to usual care in a general medical clinic. Phase I of the project is a systematic site-specific assessment of existing barriers to physician adherence to asthma guidelines in medical clinics in inner city Baltimore, MD. To create a practice environment with fewer barriers to guideline adherence, we will develop a new generalist-run asthma clinic designed to overcome the specific barriers identified at the study sites. Phase II is a clinical trial involving 560 adults with asthma, in which their physicians will be assigned to provide asthma care in the new asthma clinic vs. their usual general medical clinic. We will measure changes in adherence to guidelines and outcomes between patients assigned to this new clinic and those seen in the general medical care. This study has the potential to demonstrate: 1) The extent to which guideline adherence can be improved with a site-specific multifactorial intervention to overcome barriers to guideline implementation; 2) The differences in processes and outcomes of care between an improved practice environment for generalists vs. usual generalist care; and 3) How care should be organized for management of chronic diseases.