Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study

Table 1 Quality of Spirometry Performance and Reporting

Criterion	Pre-Intervention	During Intervention	Mean difference	Odds Ratio	p-value
Total spirometries	210	208	-	-	-
Mean No. of blows per spirometry	3.8 (3.5, 4.1)	3.7 (3.4, 4.0)	−0.08 (−0.25, 0.09)	-	0.37
Mean No. of acceptable^a blows per spirometry	1.9 (1.3, 2.5)	2.1 (1.5, 2.7)	0.22 (−0.07, 0.50)	-	0.16
Probability of spirometries with ≥3 acceptable blows	0.36 (0.16, 0.63)	0.49 (0.27, 0.72)	-	1.7 (1.1, 2.6)	0.03
Probability of spirometries with ≥2 repeatable blows^b	0.85 (0.74, 0.92)	0.93 (0.85, 0.97)	-	2.2 (1.0, 4.6)	0.05
Probability of blows with a poor start	0.06	0.05	-	0.74 (0.35, 1.6)	0.58
Probability of blows with an unsatisfactory exhalation	0.39	0.35	-	0.84 (0.62, 1.1)	0.30
Probability of blows with significant artifact	0.13	0.14	-	1.2 (0.86, 1.6)	0.34
Probability of reporting correct FVC^c	0.71 (0.57, 0.85)	0.78 (0.66, 0.90)	-	1.43 (0.72, 2.9)	0.35
Probability of reporting correct FEV1^c	0.73 (0.61, 0.85)	0.79 (0.68, 0.89)	-	1.4 (0.62, 3.0)	0.45
Probability of documenting inadequate spirometry^d	0.08 (0, 0.18)	0.12 (0, 0.18)	-	1.4 (0.73, 2.8)	0.46
Probability of identifying appropriate reason for inadequate spirometry^{e, f}	0.02 (0, 0.07)	0.06 (0, 0.13)	-	2.4 (0.67, 8.8)	0.20
Probability that spirometer was calibrated before test	0.96 (0.68, 1.0)	0.97 (0.77, 1.0)	-	1.4 (1.1, 1.9)	0.01
Probability that spirometry met both acceptability and repeatability criteria	0.32 (0.14, 0.58)	0.45 (0.25, 0.67)	-	1.7 (1.0, 3.0)	<0.05

95 % confidence intervals are provided in brackets
CI denotes confidence interval
^a“acceptable” was defined by the absence of a poor start [i.e. an extrapolated volume < 5 % of FVC or 150 mL (whichever was greater)], a satisfactory exhalation [defined by reaching a plateau in the volume–time curve, with no change in volume (<0.025 L) for ≥ 1 s], and absence of any significant artifact (including evidence of cough during the first second of exhalation, glottis closure that influences the measurement, early termination or cut-off, submaximal effort, leak, or an obstructed mouthpiece) [22]
^bamong spirometries with at least 2 acceptable blows (a spirometry was considered “repeatable” when the two largest FVC values and the two largest FEV1 values were each within 150 mL of each other) [22]
^camong spirometries with at least 1 acceptable blow
^dTechnician comments were searched for documentation that the test was inadequate (among spirometries which did not meet ATS criteria of at least 3 acceptable and 2 repeatable blows) [22]
^eTechnician comments were searched for documentation of the reason that the test was inadequate (among spirometries which did not meet ATS criteria of at least 3 acceptable and 2 repeatable blows) [22]
^fFor this outcome, applying the bootstrap method to estimate standard errors failed to converge in one-third of the replications. Therefore, results are reported using robust standard errors

ISSN: 1471-2466