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.
This study will result in the development of a validated prediction tool called the Quality Improvement Intervention Implementation Success Scale (QII-ISS). Through the proposed study we will gain a better understanding of the facilitators and barriers to successful QII implementation, develop a prediction tool based on this new knowledge, and validate the tool in a separate sample of practices. The QII-ISS we propose to develop may potentially aid medical groups, health plans, and other health care organizations to better understand a priori what supports and infrastructure they are lacking that we identify as essential for successful QII implementation. This would allow such organizations to proactively address any modifiable factors prior to investing resources into future QII programs
