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J Am Board Fam Med. 2014 May-Jun;27(3):391-8. doi: 10.3122/jabfm.2014.03.130241.

Improving quality of care and guideline adherence for asthma through a group self-assessment module.

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Family Medicine of Albemarle, Charlottesville, VA; Department of Family Medicine and Population Health, the Virginia Commonwealth University, Richmond; The American Board of Family Medicine, Lexington, KY; the Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington; and the Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke.



The quality of care for asthma remains suboptimal. Compliance with guidelines remains low, but improved adherence to guidelines may increase the quality of care. but. We conducted a trial to determine whether group Self-Assessment Module (SAM) activities led by a facilitator and conducted as part of Maintenance of Certification for Family Physicians (MC-FP) would increase knowledge of and adherence to asthma guidelines.


Participating physicians completed audits of the charts of patients with asthma before and 6 months after a group SAM. Surveys of physicians' knowledge of asthma guidelines were administered immediately before, immediately after, and 6 months after the group SAM. We tested for differences in knowledge of and adherence to guidelines before and after the SAM using χ(2) and t tests.


Thirty-eight physicians in Virginia completed the SAM and had complete data. Participants completed more MC-FP activities than other physicians but were comparable in other characteristics. Except for prescribing controller medications for persistent asthma, all other quality measures significantly improved 6 months after the group SAM. Diagnosis by severity improved from 48.3% to 80.2%, and the use of action plans increased from 8.1% to 54.1%. Physicians' knowledge of guidelines improved immediately after the SAM and was sustained at 6 months. Increased knowledge translated into clinical skills: 30% of participants reported comfort with assessing control after the SAM, which increased to 97.5% 6 months after the SAM.


Group SAMs may be an effective method to increase physicians' knowledge of and adherence to clinical guidelines.


Asthma; Certification; Educational Assessment; Guideline Adherence

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