A Practical Model to Transform Childhood Asthma Care - Spirometry Training in the Primary Care Setting

Implementing Evidence-based Quality Improvement Strategies to Improve Asthma Care for Children

Spirometry is a recommended component of asthma diagnosis and treatment in the primary care setting, however, few primary care providers report routine use of spirometry in the provision of care for their asthma patients. Even when spirometry is used to aid in asthma severity classification, primary care providers have a high rate of failing to meet the quality goals for testing established by the American Thoracic Society.

The goal of this study is to evaluate the effectiveness of a virtually delivered quality improvement (QI) program. The program is designed to train primary care providers and their medical staff in the use of spirometry to improve pediatric primary care management for children with asthma.

Study Overview

• Status: Completed
• Conditions: Asthma
• Intervention / Treatment: Behavioral: Virtually delivered spirometry quality improvement program

Detailed Description

A cluster randomized trial with matched practice pairs. All practices receive a spirometer and standard vendor training. Those randomized to the intervention group receive a 7-month QI program, which includes:

1. Spirometry Fundamentals™ CD-ROM;
2. Case-based, interactive webinars; and
3. an Internet-based spirometry quality feedback reporting system.

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Washington
    • Seattle, Washington, United States, 98195
      • University of Washington

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Internet access on a computer running Windows XP SP2
• Access to a computer with Windows 2000 /Mac OS 10 or higher

• Practices must match another enrolled practice on the following parameters.

  1. Number of providers in practice (same number +/- 1 provider)
  2. Location - both practices must either be urban or rural
  3. % of patients eligible for Medicaid (same percentage +/- 15%)
  4. Practice type (school-based clinic, Federally Qualified Health Center, private practice, hospital- or university-based clinic)
  5. Geographic distance (minimum of 10 miles away from matched pair practice)

Exclusion Criteria:

• Lack of Internet access on a computer running Windows XP SP2
• Lack of access to a computer with Windows 2000 /Mac OS 10 or higher
• Practices that were unable to be matched to another similar practice

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Standard of Care
Experimental: Intervention; Virtually delivered spirometry quality improvement program	Behavioral: Virtually delivered spirometry quality improvement program; Sites in the intervention arm receive the virtually delivered QI program. The program includes: Spirometry Fundamentals™ CD-ROM, a computer-based CD-ROM training program that teaches primary care providers and their staff techniques required to perform high-quality spirometry tests, and proper interpretation of spirometric data;; Case-based, interactive webinars; and; an Internet-based spirometry quality feedback reporting system.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Spirometry test quality	Percentage of acceptable quality spirometry tests as determined by standards set by the American Thoracic Society.	Seven months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence of asthma care plan	To assess whether exposure to the virtually delivered quality improvement (QI) program increases the frequency with which written asthma action plans are completed.	Seven months
Asthma severity documentation	To assess whether exposure to the virtually delivered quality improvement (QI) program increases the frequency with which asthma severity is appropriately documented.	Seven months
Appropriate prescription of controller therapy	To assess whether exposure to the virtually delivered quality improvement (QI) program increases the frequency with which appropriate controller therapy is prescribed.	Seven months
Frequency of office-based spirometry	To test whether exposure to the virtually delivered quality improvement (QI) program increases the frequency with which office-based spirometry is used in the management of children with asthma.	Seven months

Collaborators and Investigators

• Sponsor: University of Washington
• Investigators: Principal Investigator: Rita Mangione-Smith, MD, MPH, University of Washington/Seattle Children's Hospital; Principal Investigator: James W Stout, MD, MPH, University of Washington

Publications and helpful links

Helpful Links

• Spirometry 360 Training Program

Study record dates

Study Major Dates

• Study Start: October 1, 2007
• Primary Completion (Actual): September 1, 2008
• Study Completion (Actual): September 1, 2008

Study Registration Dates

• First Submitted: June 15, 2010
• First Submitted That Met QC Criteria: July 9, 2010
• First Posted (Estimate): July 13, 2010

Study Record Updates

• Last Update Posted (Estimate): July 13, 2010
• Last Update Submitted That Met QC Criteria: July 9, 2010
• Last Verified: July 1, 2010

More Information

Terms related to this study

• Keywords: Asthma; Pediatric; Primary Health Care; Spirometry; Education, Distance
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Immune System Diseases; Lung Diseases; Hypersensitivity, Immediate; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity; Asthma
• Other Study ID Numbers: 32583-E/B; HHSA290200600022, Task order 2 (Other Grant/Funding Number: Agency for Healthcare Research and Quality)