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University of Washington

"We envision continuing to support the ever-increasing diffusion of planned, proactive asthma care throughout our nation's primary care offices."

James W. Stout, M.D., M.P.H., Professor, Department of Pediatrics, University of Washington (Seattle, WA)

Project Snapshot

Karen Smith, M.D., University of Washington, at a NACI meeting in Baltimore, MD.
Karen Smith, M.D., University of Washington, at a NACI meeting in Baltimore, MD.

The University of Washington (UW) expanded the capacity of its NACI Strategic Partnership project, Spirometry 360, by adding a train-the-trainer program. UW recruited four "Champion Training" sites to receive online instruction and mentoring from UW on how to conduct its Spirometry 360 training and feedback program. After completing their training, UW provided one-on-one mentoring for each of the four sites as they delivered the Spirometry 360 program to the primary care practices they had recruited.

Through this process, UW aimed to develop independently sustainable training sites that would expand the number of providers across the country with access to spirometry in their office-based practices, as recommended by the National Asthma Education and Prevention Program's (NAEPP) Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma (EPR-3). Spirometry provides an objective measure of lung function useful for diagnosing asthma as well as assessing asthma severity and monitoring asthma control, two of six priority messages for improving asthma control identified by the NAEPP's Guidelines Implementation Panel (GIP) Report.

Project Goals

  1. Deliver a "NACI Champions Train-the-Trainer" program through a Virtual Learning Collaborative to "Champion Training" sites that will then deliver the Spirometry 360 training to their constituent practices.
  2. Following program participation, the "Champion Training" sites will be capable of sustained growth and delivery of the Spirometry 360 training and feedback program.

Challenges & Solutions

Challenge: Bring Champion Training sites up to speed on spirometry. UW found that the knowledge, skills, and technical capacity of its four Champion Training sites varied, making it more challenging to bring the projects to a similar level of understanding and readiness to deliver the Spirometry 360 program.

Solution: Provide technical assistance and support to reinforce training sessions. UW assigned each Champion Training site a personal mentor to review progress and troubleshoot barriers. It also instituted an ongoing listserv support and monthly check-in calls between virtual learning sessions to help monitor progress and provide genuine collaboration


"We have found over and over that delivering good asthma care takes teamwork. Excluding any member of the team, whether doctor, nurse or medical assistant can kill progress. We continue to insist that our model be instituted with small-engaged teams. A champion without a team to lead is as hampered as a team without a champion."

–James W. Stout, M.D., M.P.H., Professor, Department of Pediatrics, University of Washington

UW's request for applications to its train-the-trainer program received a very positive response, with the number of viable applicants exceeding the number of available openings. Using detailed criteria, UW selected four sites from among the applicants to be trained as Champion Training sites.

UW designed and delivered virtual learning sessions to help the Champion Training sites learn from one another, incorporate quality improvement principles and adult learning methods, and grade spirometry curves to provide feedback to practices enrolled in Spirometry 360.

UW made a studio-version recording of its webinar on grading spirometry results so that anyone who missed the webinar could access to this resource. This valuable resource also provided for booster training opportunities.

Using the training resources developed through this project, UW launched a train-the-trainer program with clinical experts in Adelaide, Australia, through the International Primary Care Respiratory Group.


University of Washington shared and collaborated with other NACI-funded projects to improve asthma care and control. For example:

Building on a connection made through the Michigan Department of Community Health, a NACI Strategic Partner and Clinical Champion, the University of Michigan Health System participated in the six-month Spirometry 360 training and feedback program conducted by UW's NACI Strategic Partnership project before becoming one of the five practice sites trained through UW's NACI Clinical Champion project to deliver Spirometry 360 to other practice sites.

UW partnered with the Medical Society of Virginia Foundation (MSVF), to offer spirometry training resources to primary care practice teams enrolled in MSVF's Clinical Champions project. As a result, UW committed to conduct spirometry training with five sites in collaboration with MSVF.

To meet its project goals, the University of Washington used online distance training and practice improvement.

Other NACI-funded projects that used UW-type approaches are:

University of Washington Spirometry 360external disclaimer
interactive Medical Training Resources (iMTR)
Box 354920
Seattle, WA 98195—4920

Last Updated January 2013