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J Asthma. 2019 Mar;56(3):273-284. doi: 10.1080/02770903.2018.1455856. Epub 2018 Apr 11.

Does cross-cultural communication training for physicians improve pediatric asthma outcomes? A randomized trial.

Author information

a Department of Health Behavior and Health Education , University of Michigan School of Public Health Ann Arbor , MI , USA.
b Department of Biostatistics , University of Michigan School of Public Health , Ann Arbor , MI , USA.
c School of Nursing, Columbia University , New York , NY , USA.
d Pediatric Pulmonary Division , Columbia University , New York , NY , USA.
e Health Science Department , New Jersey City University , Jersey City , NJ , USA.
f Priority Health , East Beltline Ave. NE, Grand Rapids , MI , USA.



Adverse cross-cultural interactions are a persistent problem within medicine impacting minority patients' use of services and health outcomes. To test whether 1) enhancing the evidence-based Physician Asthma Care Education (PACE), a continuing medical education program, with cross cultural communication training (PACE Plus) would improve the asthma outcomes of African American and Latino/Hispanic children; and 2) whether PACE is effective in diverse groups of children.


A three-arm randomized control trial was used to compare PACE Plus, PACE, and usual care. Participants were primary care physicians (n = 112) and their African American or Latino/Hispanic pediatric patients with persistent asthma (n = 867). The primary outcome of interest included changes in emergency department visits for asthma overtime, measured at baseline, and 9 and 21 months following the intervention. Other outcomes included hospitalizations, asthma symptom experience, caregiver asthma-related quality of life, and patient-provider communication measures.


Over the long term, PACE Plus physicians reported significant improvements in confidence and use of patient-centered communication and counseling techniques (p < 0.01) compared to PACE physicians. No other significant benefit in primary and secondary outcomes was observed in this trial.


PACE Plus did not show significant benefit in asthma-specific clinical outcomes. More trials and multi-component strategies continue to be needed to address complex risk factors and reduce disparities in asthma care.

TRIAL REGISTRATION: NCT01251523 December 1, 2010.


Pediatrics; control/management; education; guidelines; treatment

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