Implementing lung function measurement: WP 5 Implementing lung function measurement: WP 5.1 of the Fresh Air H2020 project Jim Stout Ben Hedrick Drew Martenson University of Washington Seattle, WA, USA Jim does intro of faculty Note for intro: What we are teaching today is perfecting a good maneuver. Common errors will be covered in Coach 2 Spirometry 360 © University of Washington

Fresh Air H2020 consortium 14 funded centers around the world 4 target countries: Greece Kyrgyzstan Uganda Vietnam 7 “Work Packages”- from better understanding LRI in children <5y, to COPD rehab, to HAP reduction, to spirometry training

This is the way it should look! Training matters… This is the way it should look! js Spirometry 360 © University of Washington

Evidence for the “Spirometry 360” Intervention Small RCT (14 pediatric practices in NY State) of online program: 1. Spirometry Fundamentals 2. Case-Based Learning Labs 3. Monthly Feedback Reports Increase in proportion of acceptable spirometry tests Increase in asthma severity labeling rates, thereby improving treatment* * Stout JW, Smith K, Zhou C, Solomon C, Dozor AJ, Garrison MM, Mangione-Smith R. Learning from a Distance: Effectiveness of online spirometry training in improving asthma care: a cluster randomized trial. Academic Pediatrics. 12(2): 88-95, March/April 2012. Spirometry 360 © University of Washington

High quality spirometry depends on good technique and proper interpretation, which both require some training and feedback. Research Questions: Can the Spirometry 360 program be successfully implemented in the target countries, resulting in quality testing and confident staff? Is the SpiroSmart phone app an acceptable means of collecting lung function, and how can the user experience be optimized?

Spirometry Fundamentals Switch to live feed from Ben Spirometry 360 © University of Washington

Learning Lab Content <60 minutes each offered through self-paced, interactive, remotely monitored LMS Coach Learning Lab 1 ATS/ERS rules for producing a good test Coach Learning Lab 2 Common errors and how to correct them Provider Learning Lab 1 (FP and Pediatrics) Case-based practice and incorporating test into asthma or COPD care. Provider/ Coach Combined Learning Lab (FP and Pediatrics) Putting it all together into a planned visit model, and more case-based practice Bonnie should new dates go here? Spirometry 360 © University of Washington

Spirometry 360: Training through Feedback Reporting System Cycle Spirometry 360 © University of Washington

SpiroSmart usability study Mobile phone spirometry application Uses built-in microphone No additional hardware needed Built-in automatic feedback software (FRS-based) Capable of One-on-One remote coaching (in progress) Automatic over-reads (in progress) Screen sharing. 1 on 1 person. Customized feedback. Only show our solution JS Bottom line now reads: Automatic over-reads (proposed for Year 2)

Lung Function Distribution (FEV1/FVC)

Near / Far Tests

Performance 20 15 Percentage Error (%) 10 5 5 0 0 PEF FEV1 FVC FEV1%

Understanding context: The beauty and challenge of Kyrgyzstan

Challenges and facilitators Limits of English language materials Internet/computer issues (these happen in the US too) Remote populations Biomass for fuel Facilitators: People with amazing work ethic, attitude for learning Clinicians dedicated to healing, (not bottom line) Stable, progressive, interested government

Dr. Aizhamal Tabyshova, Coach Extraordinaire