1. 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

2. 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

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

4. 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

5. 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?

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

7. 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

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

9. 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)

10. Lung Function Distribution
(FEV1/FVC)

11. Near / Far Tests

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

13. Understanding context: The beauty and challenge of Kyrgyzstan

14. 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

15. Dr. Aizhamal Tabyshova, Coach Extraordinaire