Improving Asthma Outcomes through Cultural Competence Training for Physicians

描述（由申请人提供）：每年在医生文化能力培训上投入大量精力和资源。此类培训几乎是美国每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，尚无严格的研究评估医生的文化能力培训是否能为患者带来更好的健康结果。本申请是对 PA-08-083 的回应。我们提议开展一项随机临床试验，涉及佐治亚州亚特兰大和纽约州的 90 名临床医生以及 1192 名非裔美国人和波多黎各哮喘儿科患者。两组患者均已被证明是哮喘患病率以及与该疾病相关的问题最高的人群。将研究两种干预措施。首先是一个经过验证的项目，即医生哮喘护理教育 (PACE)，旨在提高医生的临床治疗、沟通和咨询技能，事实证明可为普通哮喘儿童群体带来积极的结果。第二个是旨在提高临床医生的文化能力的计划版本，特别是与目标患者群体合作的文化能力（PACE PLUS）。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）为少数族裔患者（特别是非裔美国人和波多黎各儿童及其父母）带来更好的结果？ 2) 与对照组相比，PACE 计划已被证明对一般患者群体有效，对少数患者（特别是非裔美国人和波多黎各儿童及其父母）也有效。研究假设是，两种干预措施对医生的患者都会产生积极的结果，但对那些医生参加文化能力培训 (PACE PLUS) 的患者来说，结果会更好。即： a) 与 PACE 相比，PACE PLUS 将减少医疗保健使用、改善症状、提高家长对护理的满意度、提高生活质量、提高医生跨文化工作的信心、增加医生对 NAEPP 指南的使用。 b) PACE 与对照组相比，将在这六个维度上产生更好的结果。将通过对医生的调查和对孩子的父母/看护人的电话采访来收集数据。将审查医生的医疗记录，以核实家长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.