Effectiveness of the Spirometry 360 Quality Improvement Program for Improving Asthma Care: A Cluster Randomized Trial

Abstract

Objective To determine the effectiveness of the Spirometry 360™ distance learning quality improvement (QI) program for enhancing the processes and outcomes of care for children with asthma. Methods Cluster randomized controlled trial involving 25 matched pairs of pediatric primary care practices. Practices were recruited from two practice-based research networks: the Slone Center Office-based Research Network at Boston University, Boston, MA and the Puget Sound Pediatric Research Network in Seattle, WA. Study participants included providers from one of the 50 enrolled pediatric practices and 626 of their patients with asthma. Process measures assessed included: spirometry test quality and appropriate prescription of asthma controller medications. Outcome measures included: asthma-specific health-related quality of life, and outpatient, emergency department and inpatient utilization for asthma. Results At baseline, 25.4% of spirometry tests performed in control practices and 50.4% of tests performed in intervention practices were of high quality. During the six month post-intervention period, 28.7% of spirometry tests performed in control practices and 49.9% of tests performed in intervention practices were of high quality. The adjusted difference-of-differences analysis revealed no intervention effect on spirometry test quality. Adjusted differences-of-differences analysis also revealed no intervention effect on appropriate use of controller medications or any of the parent/patient-reported outcomes examined. Conclusion In this study, the Spirometry 360™ distance learning QI program was ineffective in improving spirometry test quality or parent/patient-reported outcomes. QI programs like the one assessed here may need to focus on practices with lower baseline performance levels or be tailored for those with higher baseline performance.

Statewide Asthma Learning Collaborative Participation and Asthma-Related Emergency Department Use

“…Studies of asthma-focused QI in primary care have been focused on process measures like adherence to NHLBI guidelines: tracking asthma scores by using a validated tool, 9 increasing use of asthma action plans, 9,10 increasing prescription of inhaled corticosteroids, 11,12 and increasing use of spirometry. 13 Few studies of primary care, asthmafocused QI in which researchers examine ED use exist, and the results of these studies are mixed. In 1 study, researchers reported providing education to primary care practices and implementing clinical decisionmaking tools led to a decrease in ED visits and hospitalizations for pediatric asthma patients.…”