Elsevier

Academic Pediatrics

Volume 17, Issue 8, November–December 2017, Pages 855-862
Academic Pediatrics

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

https://doi.org/10.1016/j.acap.2017.06.015Get rights and content

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 2 practice-based research networks: the Slone Center Office-based Research Network at Boston University, Boston, Mass, and the Puget Sound Pediatric Research Network, Seattle, Wash. 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 6-month postintervention 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- or patient-reported outcomes examined.

Conclusions

In this study, the Spirometry 360 distance learning QI program was ineffective in improving spirometry test quality or parent- or patient-reported outcomes. QI programs like the one assessed here may need to focus on practices with lower baseline performance levels or may need to be tailored for those with higher baseline performance.

Section snippets

Practice Participants

We conducted a cluster randomized controlled trial among 50 pediatric practices located throughout the United States. Practices were recruited from 2 practice-based research networks: the Slone Center Office-based Research Network (SCOR) at Boston University, Boston, Mass, and the Puget Sound Pediatric Research Network (PSPRN), Seattle, Wash. The study was registered at ClinicalTrials.gov (NCT01168635).

SCOR and PSPRN practices were sent postal mail or e-mail study invitations. Eligible

Results

Study invitation letters were sent to 161 practices in the SCOR and PSPRN networks. When called by study staff, 50 practices enrolled, 14 were deemed ineligible, 29 declined, and 68 could not be successfully contacted after multiple attempts, resulting in a practice response rate of 34% (50/147). Practices provided names and contact information for 22 to 196 (mode = 62) patients who were between 5 and 16 years old and who had at least 1 visit with the billing code 493.xx during the prior 12

Discussion

This cluster randomized controlled trial did not demonstrate positive effects of the Spirometry 360 QI program on asthma processes or outcomes of care in this group of pediatric practices. The lack of effect on quality of spirometry testing was surprising, given the results of a prior cluster randomized controlled trial that demonstrated a positive effect on testing quality during participation in a similar distance-learning spirometry QI program.16 However, in that trial, the number of tests

Conclusions

In this study, the Spirometry 360 distance learning QI program was ineffective in improving the quality of spirometry testing or patient-reported outcomes. Unfortunately, the lack of balance between the practice groups in baseline spirometry performance limited our ability to assess this primary outcome, which underscores the importance of ascertaining performance of key care processes before randomization and utilizing randomization methods that ensure balance. QI programs like the one

Acknowledgments

Supported in part by the National Heart, Lung, and Blood Institute (grant 1R01HL094579-01A1; Principal Investigator: Rita Mangione-Smith). The funders had no role in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication. We thank Megan Fesinmeyer, PhD, MPH, data analyst at Seattle Children's Research Institute, who conducted the data analysis for this study under the direction of C.Z.

References (17)

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Conflict of interest: The authors declare that they have no conflict of interest.

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© 2017 by Academic Pediatric Association