Barriers to Placement of Spirometers in Clinics Affiliated with an Academic Medical Center英文文献资料.docVIP

International Journal of Clinical Medicine, 2012, 3, 31-35 31 /10.4236/ijcm.2012.31006 Published Online January 2012 (http://www.SciRP.org/journal/ijcm) Barriers to Placement of Spirometers in Clinics Affiliated with an Academic Medical Center Victor O. Kolade Department of Internal Medicine, College of Medicine, University of Tennessee, Chattanooga, USA. Email: vkolade@ Received November 14 , 2011; revised December 16 , 2011; accepted December 28 , 2011 th th th ABSTRACT United States physician office visits for asthma have increased since 1989, and most of these visits are to primary care physicians. The National Institutes of Health has published guidelines for asthma diagnosis and management, imple- mentation of which is expected to result in improved care and reduced costs. Compliance with asthma guidelines has been suboptimal, especially with spirometry recommendations, and more so in primary care clinics than in specialist clinics. Noncompliance has largely been attributed to physician and patient factors. This paper describes an experience with navigation of health system barriers to implementation of spirometry encountered at three primary care clinics af- filiated with an internal medicine residency program. Included are perspectives and priorities of key individuals, sys- tems issues related to institutions, and technical issues pertaining to spirometers. Navigation of ACGME core compe- tencies is discussed. Keywords: Spirometry; Medical Education; Asthma; Systems-Based Practice 1. Introduction sites associated with an academic Department of Medi- cine initiated quality improvement programs to increase adherence to national asthma guidelines. Meetings were held with physicians, office staff, and administrators to obtain buy-in and develop local institutional