Department of Pediatrics and Health Services, University of Washington, Seattle, USA.
Acad Pediatr. 2012 Mar-Apr;12(2):88-95. doi: 10.1016/j.acap.2011.11.006.
We evaluated the effectiveness of a virtually delivered quality improvement (QI) program designed to improve primary care management for children with asthma.
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.
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).
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.
我们评估了一个虚拟交付的质量改进（QI）计划对改善儿童哮喘初级保健管理的效果。
2007 年 10 月至 2008 年 9 月，14 家初级保健儿科诊所的 36 名医生、护士和医疗助理参与了一项集群随机试验。所有诊所均配备了肺量计和标准供应商培训。在研究期间，为期 7 个月的 QI 计划包括：1） Spirometry Fundamentals™ CD-ROM，一个多媒体教程；2）由临床专家领导的基于案例的交互式网络研讨会；和 3）基于互联网的肺量计质量反馈报告系统。将实践对直接相互比较，使用混合效应回归模型分析组间差异。我们的主要结果指标是肺量计检测的频率、可接受质量的肺量计检测的百分比、哮喘严重程度的记录和适当的控制器药物的开具。
参与的实践总共上传了 1028 次肺量计检测，其中 340 次（33.1%）的质量可接受。在 7 个月的干预期间，干预和对照实践之间的肺量计检测频率没有差异。在调整基线期间的质量后，干预实践进行可接受质量检测的可能性显著高于匹配对照实践（优势比 2.85；95%置信区间 1.78-4.56，P<.001）。干预提供者在干预期间记录哮喘严重程度的可能性也显著更高（优势比 2.9，95%置信区间 1.8-4.5；P<.001）。尽管两组患者持续使用控制器药物的比例均接近 100%，但干预实践中持续哮喘患者的比例从 43%增加到 62%，而对照组则从 57%下降到 50%（无统计学意义）。
多方面的远程 QI 计划可提高肺量计的质量，并改善对哮喘严重程度的评估。成功参与 QI 计划可以远程实现。
