Improving Asthma Outcomes through Cultural Competence Training for Physicians

描述（由申请人提供）：每年在医师文化能力培训上花费大量的精力和资源。这种培训是美国几乎每一所医学院课程的一部分，也是全国继续医学教育的重点。然而，尚无严谨的研究评估医师的文化能力培训是否能改善患者的健康状况。此应用程序是对PA-08-083的响应。我们提议进行一项随机临床试验，涉及佐治亚州亚特兰大和纽约的90名临床医生，以及他们的1192名非裔美国人和波多黎各儿童哮喘患者。研究表明，这两组患者都是哮喘患病率最高的人群，并存在与哮喘相关的问题。将研究两种干预措施。首先是一个经过验证的项目，医师哮喘护理教育（PACE），旨在提高医生的临床治疗、沟通和咨询技能，为哮喘儿童的一般人群带来积极的结果。第二种是旨在提高临床医生的文化能力的课程版本，特别是在与目标患者人群（PACE PLUS）一起工作时。拟议的研究将回答两个问题：1)文化能力训练（PACE PLUS）是否比一般的沟通训练计划（PACE）对少数民族患者，特别是非洲裔美国人和波多黎各儿童及其父母产生更好的结果？2)与对照组相比，PACE项目已被证明对一般患者有效，对少数族裔患者，特别是非洲裔美国人和波多黎各儿童及其父母有效。本研究的假设是，两种干预措施对医生的患者都有积极的结果，但医生参与文化能力培训（PACE PLUS）的患者的结果更好。即：a)与PACE相比，PACE PLUS将减少医疗保健使用，改善症状，提高父母对护理的满意度，提高生活质量，提高医生对跨文化工作的信心，增加医生对NAEPP指南的使用。与对照组相比，在这六个方面会产生更好的结果。数据将通过对医生的调查和对儿童父母/看护人的电话访谈来收集。医生的医疗记录将被审查，以核实父母的医疗保健使用报告。

DESCRIPTION (provided by applicant): Massive effort and resources are expended every year on cultural competence training for physicians. Such training is part of the curriculum of virtually every medical school in America and a focus of continuing medical education nationwide. However, no rigorous study has assessed whether cultural competence training for physicians results in better health outcomes for their patients. This application is in response to PA-08-083. We propose to conduct a randomized clinical trial involving 90 clinicians in Atlanta, Georgia and New York, New York and 1192 of their African American and Puerto Rican pediatric patients with asthma. Both groups of patients have been shown to be among those with the highest prevalence of asthma and problems associated with the condition. Two interventions will be studied. First is a proven program, Physician Asthma Care Education (PACE), for enhancing physicians' clinical therapeutics, communication, and counseling skills shown to produce positive outcomes for the general population of children with asthma. The second is a version of the program designed to enhance the cultural competence of the clinician, specifically, in working with the target patient population (PACE PLUS). The proposed study will answer two questions: 1) Does cultural competence training (PACE PLUS) produce better outcomes for minority patients, specifically African American and Puerto Rican children and their parents than a general communication training program (PACE)? 2) Compared to a control group, is the PACE program, already shown to be effective with the general population of patients, effective when used with minority patients, specifically African American and Puerto Rican children and their parents. The study hypothesis is that there will be positive outcomes for patients of physicians in both interventions but better outcomes for those patients whose doctors participate in the cultural competence training (PACE PLUS). That is: a) PACE PLUS compared to PACE will produce reductions in health care use, improved symptoms, greater parent satisfaction with care, enhanced quality of life, higher levels of physician confidence in working cross culturally, increased use of NAEPP guidelines by physicians. b) PACE Compared to a control group will produce better outcomes on these six dimensions. Data will be collected through survey of physicians and telephone interviews with the child's parent/caretaker. Medical records of physicians will be reviewed to verify parent's reports of health care use.