Elsevier

Academic Pediatrics

Volume 12, Issue 2, March–April 2012, Pages 88-95
Academic Pediatrics

Health Care Delivery Research
Learning from a Distance: Effectiveness of Online Spirometry Training in Improving Asthma Care

https://doi.org/10.1016/j.acap.2011.11.006Get rights and content

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.

Section snippets

Methods

Collaborators at the New York Department of Health identified 28 potentially eligible pediatric practices from their asthma QI consortium in September/October 2007. Eight of these practices did not adequately match other eligible practices. Sixteen of the remaining 20 practices were enrolled (eligible response rate = 80%; Fig. 1). Thus, 8 practice pairs were matched on the following criteria: number of pediatric providers (±1); urban versus suburban/rural location; percent of Medicaid-eligible

Results

Sixteen practices (8 matched pairs) were recruited and enrolled, but one intervention practice dropped out because of competing priorities, leaving 7 matched practice pairs. Most practices (11/14) provided care primarily for Medicaid-insured populations. Most practices were urban, ranged in size from a solo practice to 10-provider practices, and represented a variety of practice types (Table 2). The number of participants in the intervention practices ranged from 1 to 6 providers. Seven of the

Discussion

We successfully delivered a multifaceted spirometry distance-training program from Seattle, Washington, and other faculty locations to seven pediatric practices in New York. The percentage of acceptable quality spirometry sessions performed among intervention practices increased significantly compared with controls. Other findings support the stated program aim: improving primary care management of children with asthma. During the 7-month QI program, intervention practices had a significantly

Conclusions

A multifaceted distance QI training and feedback program resulted in increased spirometry quality and improved assessment of asthma severity levels. Successful participation in QI programs focused on procedures such as spirometry can occur over distance.

Acknowledgments

We gratefully acknowledge the help of Ms. Patricia A. Waniewski RN, MS, for recruitment of both faculty and practice teams; Mr. Jeff Byrne RRT, for leading the coaching webinars; Mr. Carl Zimmer from Biomedical Systems for reporting system support; and Ms. Julie Peterson, Ms. Alexis Coatney, Ms. Alison Long, and Ms. Bonnie Rains for project coordination and support. Funded by the Agency for Healthcare Research and Quality Grant HHSA290200600022, Task Order 2, 2007-2009, and administered by the

References (26)

  • S. Suissa et al.

    Low-dose inhaled corticosteroids and the prevention of death from asthma

    N Engl J Med

    (2000)
  • R.J. Adams et al.

    Impact of inhaled antiinflammatory therapy on hospitalization and emergency department visits for children with asthma

    Pediatrics

    (2001)
  • M.J. Buxton et al.

    Country-specific cost-effectiveness of early intervention with budesonide in mild asthma

    Eur Respir J

    (2004)
  • Cited by (30)

    • Barriers and Enablers to Objective Testing for Asthma and COPD in Primary Care: A Systematic Review Using the Theoretical Domains Framework

      2022, Chest
      Citation Excerpt :

      Eaton and colleagues58 successfully (although transiently) improved both spirometry knowledge and technical competence among physicians and nurses through an in-person spirometry workshop. Others demonstrated that technical competence also could be improved through interactive web-based training.46,59 However, an intensive training program failed to increase the actual use of spirometry,60 supporting our finding of barriers across multiple domains.

    • The role of objective tests to support a diagnosis of asthma in children

      2020, Paediatric Respiratory Reviews
      Citation Excerpt :

      The key factor is in the provision of adequate educational opportunities and time to support nurses in spirometry training, as well as to address the potential increase in costs for practices. Designed programmes to deliver virtual spirometry training in primary care are rarely used, but have shown increased spirometry quality and improved recognition of asthma severity levels [40]. The Association for Respiratory Technology and Physiology (ARTP) are the guardians of quality spirometry in the UK.

    • Webinars in higher education and professional training: A meta-analysis and systematic review of randomized controlled trials

      2019, Educational Research Review
      Citation Excerpt :

      First, webinar characteristics include the length of webinar events and how often webinar events were cast. For example, some webinars are as short as 30 min (e.g., Nelson, 2010) while other webinars can last several hours (e.g., Spalla, 2012; Stout et al., 2012). Similarly, some webinars are single events (e.g., McMahon-Howard & Reimers, 2013) while other webinar events are repeated several times (e.g., Carrick et al., 2017).

    • Spirometry: Tool for pharmacy practitioners to expand direct patient care services

      2013, Journal of the American Pharmacists Association
      Citation Excerpt :

      The evolution of the role of the pharmacist as part of the medical team in primary care has expanded to include not only managing diseases such as diabetes and hypertension but also respiratory illnesses. Over the course of several decades, the integration of established pulmonary function testing in primary care has become more commonplace; however, the results regarding improved quality of care have been mixed.22,23 These mixed results may be due to a variety of factors, including poor quality testing and suboptimal selection and use of available medications.

    View all citing articles on Scopus
    View full text