Improving Asthma Outcomes through Cultural Competence Training for Physicians

描述（由申请人提供）：每年都花费大量的精力和资源用于医生的文化能力培训。这种培训是美国几乎所有医学院课程的一部分，也是全国继续医学教育的重点。然而，没有严格的研究评估医生的文化能力培训是否会为患者带来更好的健康结果。本申请是对PA-08-083的回应。我们建议进行一项随机临床试验，涉及90名临床医生在亚特兰大，格鲁吉亚和纽约，纽约和他们的1192名非洲裔美国人和波多黎各儿童哮喘患者。这两组患者都被证明是哮喘患病率最高的人群，也是与哮喘相关的问题最多的人群。将研究两种干预措施。首先是一个经过验证的计划，医生哮喘护理教育（PACE），用于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产生积极的结果。第二个版本的计划旨在提高临床医生的文化能力，特别是在与目标患者人群（PACE PLUS）合作方面。拟议的研究将回答两个问题：1）文化能力培训（PACE PLUS）是否比一般沟通培训计划（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计划已被证明对一般患者有效，对少数民族患者有效，特别是非洲裔美国人和波多黎各儿童及其父母。研究假设是，在两种干预措施中，医生的患者将获得积极的结果，但医生参加文化能力培训（PACE PLUS）的患者的结果更好。那就是：a）与PACE相比，PACE PLUS将减少医疗保健的使用，改善症状，提高父母对护理的满意度，提高生活质量，提高医生在跨文化工作中的信心，增加医生对NAEPP指南的使用。B）与对照组相比，PACE在这六个维度上会产生更好的结果。将通过对医生的调查和对儿童父母/看护人的电话采访收集数据。将审查医生的医疗记录，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.