The Provider and Organization in Asthma Guidelines

描述(由申请人提供)： 只有不到20%的初级保健提供者遵守国家哮喘指南。旨在提高提供者遵守指南的干预措施取得了不大的成功。我们认为，必须结合提供商的环境来看待提供商行为的改变。我们假设，在实施和维持哮喘管理计划方面最成功的提供者将具有一系列与哮喘相关的个人属性，其特征是随时准备改变、高自我效能、积极的结果预期和高结果价值，并将在促进和支持此类活动的组织中工作。我们建议进行两个阶段的研究。在第1阶段(第1年)，将举行调查工具开发和测试以及讨论干预措施的提供者会议。49家诊所/诊所的提供者正在使用一种名为Easy Breats的哮喘管理计划，他们将完成这些调查，这些调查将表征诊所/诊所/诊所的组织和组织文化，以及提供者与哮喘有关的个人属性。在第2-5年，将在其中36个诊所/实践中对行为干预、组织干预或不干预(对照)进行随机对照研究。行为部门的诊所/实践将接受干预，包括专家建模、特定于项目、诊所和提供者的反馈，以及意见领袖和学术细节的使用。组织部门的诊所/做法将得到干预，包括基准、领导能力培训和团队建设以及奖励/奖励。主要结果变量是提供者和诊所/时间单位完成的轻松呼吸调查的次数。我们之前已经表明，通过完成一项调查证明，登记使用舒缓呼吸(直接根据国家哮喘指南进行调整)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有关。因此，这项研究将调查提供者个人属性和组织之间的复杂交互作用，以及有针对性的干预对提供者绩效的影响，以实施哮喘疾病管理计划。这些数据随后将用于未来的研究，以确定如何在成本受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.