Abstract
Objective
We evaluated the effectiveness of a virtually delivered quality improvement (QI) program
designed to improve primary care management for children with asthma.
Methods
Thirty-six physicians, nurses, and medical assistants from 14 primary care pediatric
practices (7 matched practice pairs) participated in a cluster randomized trial from
October 2007 to September 2008. All practices received a spirometer and standard vendor
training. A 7-month QI program delivered during the study period included: 1) Spirometry
Fundamentals™ CD-ROM, a multimedia tutorial; 2) case-based, interactive webinars led
by clinical experts; and 3) an internet-based spirometry quality feedback reporting
system. Practice pairs were compared directly to each other, and between-group differences
were analyzed with the use of mixed effects regression models. Our main outcome measures
were the frequency of spirometry testing, percentage of acceptable quality spirometry
tests, asthma severity documentation, and appropriate controller medication prescribing.
Results
Participating practices uploaded a total of 1028 spirometry testing sessions, of which
340 (33.1%) were of acceptable quality. During the 7-month intervention period, there
was no difference between intervention and control practices in the frequency of spirometry
tests performed. Intervention practices were estimated to have significantly greater
odds of conducting tests with acceptable quality compared with matched control practices,
adjusting for quality in the baseline period (odds ratio 2.85; 95% confidence interval
1.78–4.56, P < .001). Intervention providers also had significantly greater odds of documenting
asthma severity during the intervention period (odds ratio 2.9, 95% confidence interval
1.8–4.5; P < .001). Although use of controller medications among patients with persistent asthma
approached 100% for both groups, the proportion of asthma patients labeled as persistent
increased from 43% to 62% among intervention practices, and decreased from 57% to
50% among controls (NS).
Conclusions
A multifaceted distance QI program resulted in increased spirometry quality and improved
assessment of asthma severity levels. Successful participation in QI programs can
occur over distance.
Keywords
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Article Info
Publication History
Accepted:
November 19,
2011
Received:
June 20,
2011
Identification
Copyright
© 2012 Published by Elsevier Inc.
