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

Study Overview
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Brief Summary
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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.

Detailed Description
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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: Spirometry Fundamentals™ CD-ROM; Case-based, interactive webinars; and an Internet-based spirometry quality feedback reporting system.

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

Conditions
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Asthma

Intervention / Treatment
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* Behavioral: Virtually delivered spirometry quality improvement program


Participation Criteria
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Eligibility Criteria
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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. Number of providers in practice (same number +/- 1 provider) Location - both practices must either be urban or rural % of patients eligible for Medicaid (same percentage +/- 15%) Practice type (school-based clinic, Federally Qualified Health Center, private practice, hospital- or university-based clinic) 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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Virtually delivered spirometry quality improvement program | Behavioral: Virtually delivered spirometry quality improvement program<br>* 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.<br>|
| No Intervention: Standard of Care<br> | |

What is the study measuring?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Asthma, Spirometry, Pediatric, Primary Health Care, Education, Distance