Improving Asthma Outcomes Through Cultural Competence Training for Physicians

Massive resources are expended every year on cultural competence training for physicians.
However no rigorous study that has assessed whether cultural competence training for
physicians results in better health outcomes for their patients.

The investigators propose to conduct a randomized clinical trial to compare two
interventions. The study will involve three groups. The first, Physician Asthma Care
Education (PACE), is a proven program for enhancing communication, therapeutic practice and
the ability of physicians to foster effective management of asthma by their patients in
general. The second is the PACE program plus skills and concepts considered in the
literature essential to culturally competent practice (PACE PLUS). It is designed to give
clinicians a higher degree of certainty and confidence in working across cultures. PACE PLUS
was specifically developed to enable physicians to understand and overcome potential biases
in their interactions with patients whose racial/ethnic identity is different from their
own. The third is a control group that will not receive an intervention. Two racial/ethnic
groups of patients will be the focus of the research: African American and Latino/Hispanic,
specifically, Puerto Rican children with asthma and their parents or caretakers. The
proposed study will evaluate the effects of the training for physicians on health outcomes
for the children and performance ratings given to the physician by the parent of the child.

The proposed study will address two questions:

1. Does cultural competence training (PACE PLUS) produce better outcomes for minority
patients, specifically African American and Puerto Rican children, and their respective
parents, than a general communication training program (PACE)?

2. Compared to the control group, is the Physician Asthma Care Education program (PACE),
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:

1. PACE PLUS compared to PACE will produce:

- reductions in children's health care use for asthma

- improved symptom experience for the children

- greater parent/caretaker satisfaction with the physician's performance

- enhanced asthma related quality of life for parents/caretakers of the patients

- higher levels of confidence and value placed by physicians on skills needed when
working cross culturally

- increased use of National Asthma Education and Prevention Program (NAEPP)
recommended therapies by physicians

2. PACE compared to a control group will produce better outcomes on these six dimensions.

Inclusion Criteria:

- Physician enrollment criteria are: 1) licensed physician in practice and board
certified in pediatrics or family medicine; 2) treating children with asthma; 3)
full-time in a practice in Atlanta, GA or New York City, NY; 4) not Latino/Hispanic
or African American in ethnicity/race; 5) consenting to participate and 6) will
generate a roster of pediatric asthma patients.

The following patient selection criteria will be used.

- The child must: 1) be treated by the participating physician during the study intake
period; 2) be between one and 16 years of age; 3) have a diagnosis of asthma made by
a physician using the NAEPP Guidelines for the diagnosis of asthma (NHLBI, 2007) (The
investigators will not accept alternative descriptions such as reactive airway
disease, bronchitis, or wheezy bronchitis. The determination must be asthma); 4) have
at least one emergency medical care visit in the previous year (hospitalization, or
ED or physician office visit on an emergency basis defined as administration of
epinephrine sub-cutaneously or bronchodilators by aerosol); 5) not have other chronic
disorders that have pulmonary complications, e.g. sickle cell disease; 6) be of
self-identified African American or Latino/Hispanic race/ethnicity.

- In addition, the parent/caretaker must meet the following criteria: 1) be the one
usually responsible for the child's car; 2) be of self identified African American or
Latino/Hispanic race/ethnicity; 3) have access to a telephone; and 4) consent to
participate.

Exclusion Criteria:

- Physicians and patients who cannot meet the above inclusion criteria