Improving Asthma Outcomes Through Spirometry Distance Learning

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，会发生哮喘严重程度的错误分类。这种错误分类可能导致治疗不足、发病率增加和医疗保健利用率/成本增加。本研究的目的是测试名为“肺活量测量360”的远程学习质量改进项目的有效性，该项目由华盛顿大学儿童健康研究所的互动性医学培训资源（iMTR）小组开发。肺活量测量360项目旨在通过提高提供者对基于办公室的肺活量测量的使用和解释相关的知识和自我效能来改善对哮喘儿童的护理。肺活量测量360计划包括：1)“肺活量测量基础”：肺功能测试基本指南，这是一个基于计算机的培训计划，教导初级保健提供者如何：A)指导患者进行高质量的肺活量测量测试；b)准确解释肺活量测量数据；2)肺活量测定学学习实验室：肺活量测定学的案例教学在交互式虚拟课堂环境中通过临床实例指导测试管理员和口译员。这些会议由临床专家领导，并存档以供将来参考和回顾。3)肺活量反馈：对提供者的肺活量测试会话进行量身定制的分析，提供每月由临床专家对临床进行的肺活量测试进行个性化反馈报告。为了测试肺活量测量360的有效性，我们将在全美50家初级保健儿科诊所进行一项随机对照试验。25个实践将获得完整的肺活量测量360计划。另一组25个匹配的对照操作将接受设备供应商提供的标准肺活量测定培训。实践水平的护理质量将通过检查肺活量测定试验的质量和干预与对照实践中适当控制者用药的频率来衡量。患者层面的护理质量将通过检查哮喘特定健康相关的生活质量、因哮喘加重而计划外就诊的次数、因哮喘而住院的次数和哮喘护理的费用来评估。如果肺活量测量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范围内广泛传播给医疗保健提供者。

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.