The Provider and Organization in Asthma Guidelines
The Provider and Organization in Asthma Guidelines
The purpose of this study is to examine the interaction between the personal attributes of
 clinicians and the organizations in which they work and the effect of interventions on their
 ability to implement an asthma disease management program. +
Less than 20% of primary care providers adhere to national asthma guidelines. Interventions
 to improve provider adherence to guidelines have had modest success. We believe that changing
 provider behavior must be viewed in the context of the provider's environment. We hypothesize
 that providers who are most successful in implementing and sustaining asthma management
 programs will have a set of personal attributes, related to asthma, characterized by
 readiness to change, high self-efficacy, positive outcome expectancies and high outcome value
 AND will work within organizations that facilitate and support such activities. We propose a
 two phase study. In Phase 1 (Year 1) survey instrument development and testing and provider
 meetings to discuss the interventions will occur. Providers in 49 practices/clinics that are
 using an asthma management program called Easy Breathing, will complete these surveys that
 will characterize the organization and organizational culture of the clinics/practices and
 the provider personal attributes surrounding asthma. In Years 2-5, a randomized, controlled
 study of either a behavioral intervention, an organizational intervention or no intervention
 (control) will be performed in 36 of these clinics/practices. Clinics/practices in the
 behavioral arm will receive an intervention consisting of expert modeling, program-, clinic-
 and provider-specific feedback, and use of opinion leaders and academic detailing.
 Clinics/practices in the organizational arm will receive an intervention consisting of
 benchmarking, leadership capability training and team building and incentives/ rewards. The
 primary outcome variable is the number of Easy Breathing surveys completed by provider and by
 clinic/unit of time. We have previously shown that enrollment in Easy Breathing (which was
 adapted directly from the national asthma guidelines) as demonstrated by completion of a
 survey is a surrogate indicator of inhaled corticosteroid use and is associated with
 decreased medical services utilization. This study will thus investigate the complex
 interactions between provider personal attributes and the organization and the effect of
 targeted interventions on provider performance to implement an asthma disease management
 program. These data will then be used in future studies to determine how to better tailor
 interventions in a cost constrained environment.
Inclusion Criteria:

 -  Must have used Easy Breathing Disease Management Program for more than one year.

 Exclusion Criteria:

 -  None