Predicting Success in Implementing a Distance QI Intervention for Asthma

描述（由申请人提供）：肺活量测定法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将其常规用于哮喘儿童。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，并可能导致治疗不充分、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项目，称为肺活量测量360。这种质量改善干预（QII）是一个基于办公室的项目，旨在通过提高提供者的知识和自我效能感来改善哮喘患者的呼吸护理，这些知识和自我效能感与肺活量测定的使用和解释有关。肺活量测量360程序包括：

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.