Improving Asthma Outcomes Through Spirometry Distance Learning

描述（由申请人提供）：肺功能测定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其在哮喘儿童中的常规使用。当评估仅基于症状时，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/成本增加。本研究的目的是测试远程学习质量改善计划称为肺活量360开发的互动医疗培训资源（iMTR）组在华盛顿大学儿童健康研究所的有效性。肺量测定360计划旨在通过提高提供者对使用和解释基于办公室的肺量测定的知识和自我效能来改善对哮喘儿童的护理。肺活量测定360计划包括：1）“肺活量测定基础知识”：肺功能测试的基本指南”，这是一个基于计算机的培训计划，教授初级保健提供者如何：a）指导患者进行高质量的肺活量测定测试和B）准确解释肺活量测定数据; 2）肺活量测定学习实验室：基于案例的肺量测定教学在实践中指导测试管理员和口译员通过互动的虚拟教室设置的临床例子。这些会议由专家临床教师领导，并存档供将来参考和审查。3)肺活量测定反馈：对提供者的肺活量测定测试会话进行量身定制的分析，提供临床专家对诊所进行的肺活量测定测试的每月个性化反馈报告。为了测试Spirometry 360的有效性，我们将在美国50家初级保健儿科诊所进行一项随机对照试验。25个诊所将接受完整的肺活量测定360计划。另一组25名匹配的对照实践者将接受设备供应商提供的标准肺量测定培训。将通过检查肺量测定测试会话的质量以及干预与对照实践中适当控制药物使用的频率来测量实践水平的护理质量。将通过检查哮喘特异性健康相关生活质量、哮喘急性发作计划外访视次数、因哮喘住院和哮喘护理费用来评估患者水平的护理质量。如果肺活量测定360计划被证明是改善哮喘儿童医疗保健的有效方法，我们预计它可以广泛传播给全国的医疗保健提供者。 公共卫生相关性：这项研究将是第一个严格测试在哮喘儿童管理中使用肺量测定法是否真的会改善这些儿童的哮喘相关结果的研究。建立一个证据体系，将高质量的护理过程与该护理的预期结果联系起来，是说服初级保健提供者遵循与这些护理过程相关的建议的第一个关键步骤。如果我们提出的干预措施增加了国家哮喘教育和预防计划推荐的肺量测定的提供者利用率，并改善了哮喘儿童的医疗保健结果，我们预计它可以广泛传播给医疗保健提供者，从而降低全国哮喘相关的发病率。

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.