Evaluating the implementation of a multi-component intervention to improve technical quality of primary care spirometry

Résumé fourni par la source

Background: Spirometry quality can be variable in primary care and may contribute to misdiagnosis. There are limited data on effective interventions designed to improve the technical quality of spirometry. Aim: To describe the design and implementation of a quality improvement initiative to improve spirometry quality in a real-world, primary care setting. Methods: Stakeholder events collaboratively designed a multi-component intervention across 2 phases. In phase 1, the intervention comprised: 1) Practitioner training programme; 2) Spirometers changed from portable to desktop devices allowing real-time visualisation of flow volume and volume-time graphs; 3) Move to a centralised primary care spirometry hub. Phase 2 comprised addition of AI powered spirometry support software (ArtiQ, Belgium). Effectiveness was measured by comparing the proportion of individual spirometry sessions with FEV1 and FVC achieving good quality (grades A or B according to ERS/ATS Technical standards) pre-, phase 1 and phase 2 intervention periods. Reference quality was determined by consensus of expert physiologists with a consecutive sample of 200 sessions from the pre-intervention period acting as baseline and 50 consecutive sessions from each of the two phases. Results: The proportion of sessions where FEV1 was classified as “good” increased from 55.6% (Pre-Phase 1) to 90% (Phase 1) then 96% (Phase 2) (Chi p<0.0001). The proportion of sessions where FVC was classified as “good” increased from 20.7% to 88% then 94% (Chi p<0.0001). Discussion: Implementation of a multi-component intervention significantly increased the technical quality of primary care spirometry.

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