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University of Washington

"[Spirometry 360 is] an interactive online training and feedback program. We deliver it to primary care offices, pediatrics, family practice, internal medicine, nurse practitioners, anyone interested in learning how to either begin doing spirometry or refine their technique."

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

James W. Stout, M.D., M.P.H., Professor, Department of Pediatrics, University of Washington describes the Spirometry 360 project.

Project Snapshot

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

To promote the effective use of spirometry in diagnosing and managing asthma, the University of Washington (UW) delivered its Spirometry 360 training and feedback program throughout the United States to clinicians and other staff at primary care practices that serve vulnerable populations. Spirometry provides an objective measure of lung function, recommended for diagnosing asthma, assessing asthma severity, and monitoring asthma control. UW aimed to increase the capacity of primary care practices to perform high-quality spirometry and to follow the six priority messages for improving asthma control identified by the National Asthma Education and Prevention Program's (NAEPP) Guidelines Implementation Panel (GIP) Report.

UW's Spirometry 360 is an evidence-based program that combines in-person quality improvement methods with distance training. It provides a computer-based, self-paced tutorial; interactive case-based teaching led by expert clinical faculty; and customized feedback reports from clinical experts summarizing the quality of spirometry performed in participating clinics. Spirometry 360 qualified for Maintenance of Certification, Part IV credit with the American Board of Pediatrics and the American Board of Family Medicine.

Project Goals

  1. Conduct a proven online training designed to educate "safety net" providers and their support staff in busy primary care settings on how to incorporate, perform, and interpret spirometry, with an emphasis on quality, efficiency, and return on investment.
  2. Engage primary care providers in a quality improvement program that empowers them to deliver high-quality asthma care through planned office visits that incorporate spirometry in severity and control assessments, and in written asthma action plans for patient management support.

Challenges & Solutions

Challenge: Prevent poor performance due to equipment problems. A portion of the practices that applied to participate in Spirometry 360 had either no spirometer or a spirometer that performed inadequately. At least one practice site with equipment problems dropped out of the training program while several others struggled to participate.

Solution: Screen for equipment problems prior to the training. UW refined its screening process to ask applicants to send sample spirometry tests to UW prior to joining the program. For those applicants without access to a functional spirometer, UW provided free loaner spirometers as needed for use during the program. Once their equipment problems were resolved, these practices were able to submit their spirometry results to UW on a regular basis for review and feedback.


Spirometry 360 qualified for Maintenance of Certification, Part IV credit with the American Board of Pediatrics and the American Board of Family Medicine.

University of Washington's Spiro360 Feedback Agent enabled automatic uploading of spirometry curves from an increasing number of Spirometry 360 training practices.

James W. Stout, M.D., M.P.H., head of the NACI University of Washington project, was interviewed in a NACI In the Know eNewsletter.

James W. Stout, M.D., M.P.H., University of Washington, discusses Spirometry 360 with colleagues at a NACI meeting in Baltimore, MD.


University of Washington shared and collaborated with additional NACI-funded projects to advance asthma care best practices. For example:

Two NACI Demonstration Projects—Dorchester House Multi-Service Center and Calais Regional Medical Services Rural Health Clinic (Medical Care Development)—were among more than 200 primary care practices from across the United States that participated in Spirometry 360 during the two-year project period. Thirty of these practices received NACI-funded scholarships to participate in the program.

To help meet its project goals, 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 February 2015