Spirometry is a recommended component of asthma diagnosis and treatment in the primary care setting, however, few primary care providers report routine use of spirometry in the provision of care for their asthma patients. Even when spirometry is used to aid in asthma severity classification, primary care providers have a high rate of failing to meet the quality goals for testing established by the American Thoracic Society.

The goal of this study is to evaluate the effectiveness of a virtually delivered quality improvement (QI) program. The program is designed to train primary care providers and their medical staff in the use of spirometry to improve pediatric primary care management for children with asthma.

A cluster randomized trial with matched practice pairs. All practices receive a spirometer and standard vendor training. Those randomized to the intervention group receive a 7-month QI program, which includes:

1. Spirometry Fundamentals™ CD-ROM;
2. Case-based, interactive webinars; and
3. an Internet-based spirometry quality feedback reporting system.

Inclusion Criteria:

• Internet access on a computer running Windows XP SP2

• Access to a computer with Windows 2000 /Mac OS 10 or higher

• Practices must match another enrolled practice on the following parameters.

  1. Number of providers in practice (same number +/- 1 provider)
  2. Location - both practices must either be urban or rural
  3. % of patients eligible for Medicaid (same percentage +/- 15%)
  4. Practice type (school-based clinic, Federally Qualified Health Center, private practice, hospital- or university-based clinic)
  5. Geographic distance (minimum of 10 miles away from matched pair practice)

Exclusion Criteria:

• Lack of Internet access on a computer running Windows XP SP2
• Lack of access to a computer with Windows 2000 /Mac OS 10 or higher
• Practices that were unable to be matched to another similar practice