• 1) The proportion of patients prescribed inhaled corticosteroids
  

• 1) The proportion of patients reporting instruction on the proper inhaler technique
  
• 2) The proportion of patients reporting that asthma triggers were discussed
  
• 3) The proportion of patients instructed to use short-acting beta-agonists as needed.
  
• 4) The proportion of patients instructed to use a peak flow meter
  
• 5) The proportion of patients who received a written action plan for exacerbations
  
• 6) The proportion of patients reporting nocturnal asthma symptoms in the past month
  
• 7) The proportion of patients reporting regular use of a rescue inhaler daily.
  

In the year 2000, the American Board of Internal Medicine introduced continuous professional development as part of its board recertification process. The purpose of these changes were to achieve the following goals:

• To improve the quality of patient care;
• To affirm the high standards expected of a self-regulating, accountable profession;
• To foster continuing scholarship and self-improvement;
• To offer diplomats a portfolio of credentials attesting to competence; and
• To add value to the health care system.

The most notable change in the new recertification process was the addition of practice improvement modules (PIMs). These modules require physicians to review how well they manage a particular chronic disease within their practice and to develop an improvement plan for their practice. In April 2005, it became a requirement that all internists complete a PIM as part of board recertification.

Currently, it not known whether having physicians evaluate their management of certain diseases as part of board recertification will achieve its intended goal of improving patient care. Therefore, the purpose of this trial is to assess whether practice improvement modules result in improved clinical performance.

The PIM selected for this study will focus on asthma. As PIMs seek to improve the quality of care within a practice, the unit of randomization in this study will be clinics (i.e., practices) within the Henry Ford Health System. We will enroll practicing, board-certified internists within the Henry Ford Medical Group (~40 internists or 20 per arm). Clinics (~16 or 8 per arm) will then be randomized to either complete the PIM or not complete the PIM. Participating internists at a site randomized to complete the PIM will be encouraged to work together to complete the asthma PIM. Participating internists at control sites will continue usual care and will not be asked to complete an asthma PIM.

Comparisons: We will assess differences in asthma care by prospectively surveying patients seen by physicians in the intervention group and control group following the intervention period. These analyses will be adjusted by the baseline characteristics of asthma patients seen by participating physicians.