Physician Asthma Care Education (PACE)

While understanding of asthma has increased in recent years, the morbidity and mortality associated with this chronic condition continue to comprise a major health dilemma. Although new and better treatments for asthma become available each year, the latest information on these new treatments often is not communicated effectively to patients. Even when patients do receive information on new treatments, they often believe communication with their clinicians has been inadequate. These communication problems lead to ineffective management of the disease.The Physician Asthma Care Education (PACE) program was created to enhance treatment of asthma and the physician-patient partnership.

The multi-faceted seminar was developed to improve physician awareness, ability, and application of communication and therapeutic skills for asthma. The PACE curriculum provides education for clinicians on how to employ the best current therapies for asthma. It also provides valuable information on how to communicate more effectively with patients and support patients' management efforts, helping them to better utilize the clinicians' recommendations. An original trial supported by the National Heart Lung and Blood Institute (NHLBI) showed significant outcomes for children with asthma and greater satisfaction with physician performance. 600 patients of 83 pediatricians in New York and Michigan who participated in PACE were followed from baseline through two years follow-up care. The study showed that physicians who participated in the program provided clear and concise asthma education and more effective treatment than controls. Their patients had fewer days with symptoms, fewer emergency room visits, and reduced hospitalizations compared to patients of control group physicians.With support from the Robert Wood Johnson Foundation, similar results were found in a subsequent trial replicating the PACE program in 10 cities across the United States, involving over 100 primary care providers and 870 patients. The program was delivered through peer teaching by local physicians. Evaluation showed that physicians who had attended the PACE program were more likely to inquire about patients' concerns, encourage physical activity, and set goals for successful treatment. Patients of physicians that participated in the program had fewer days affected by asthma symptoms, as well as fewer emergency room visits. Additionally, patients who began the study with more frequent asthma symptoms and higher health care utilization were more likely to benefit from their physician's participation in the PACE program. PACE physicians spent no more time with their patients than other physicians.

The PACE curriculum, including a complete set of materials needed to present a PACE seminar, is being distributed through the NHLBI of the National Institutes of Health.

You may also click here to be redirected to download the PACE manual.

Project-related Publications:

Cabana, M.D., Bruckman, D., Bratton, S.L., Kemper, A.R., Clark, N.  Association between outpatient follow-up and pediatric emergency department asthma visits.  Journal of Asthma, 40(7): 741-9, 2003.

Cabana, M.D., Bruckman, D., Meister, K., Bradley, J.F., Clark, N. Documentation of asthma severity in pediatric outpatient clinics.  Clinical Pediatrics, 42(2): 121-125, March, 2003.

Cabana, M.D., Rand, C. , Slish, K., Nan, B., Davis, M.M., Clark, N.M. Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking.  Pediatrics, 113(1): 78-81, 2004. 

Cabana, M.D., Slish, K.K., Lewis, T.C., Brown, R., Nan, B., Lin, X., Clark, N.M. Parental management of asthma triggers within a child's environment.  Journal of Allergy and Clinical Immunology, 114: 352-357, 2004.

Brown, R., Bratton, S.I., Cabana, M., Kaciroti, N., Clark, N.M. Physician asthma education program improves outcomes for children of low income families. Chest, 126(2): 369-374, 2004.

Cabana, M.D., Slish, K.K., Brown, R., Clark, N.M. Pediatrician attitudes and practices regarding collaborative asthma education.  Clinical Pediatrics, 43(3): 269-274, April, 2004. 

Cabana, M.D., Slish, K.K., Nan, B., Clark, N.M. Limits of the HEDIS criteria in determining asthma severity in children. Pediatrics, 114: 1049-1055, October, 2004.

Cabana, M.D., Brown, R., Clark, N.M., White, D.R., Lyons, J., Wanner Lang, S., Bratton, S.L. Improving physician attendance at educational seminars sponsored by managing care organizations. Managed Care, 13(9): 49-57, September, 2004.

Cabana, M.D., Slish, K.K., Nan, B., Lin, X., Clark, N.M. Asking the correct questions to assess asthma symptoms. Clinical Pediatrics, 44: 319-325, May, 2005.

Cabana, M.D., Bradley, J., Meurer, J.R., Holle, D., Santiago, C., Clark, N.M. Coding for asthma patient education in the primary care setting. Journal of Medical Practice Management, 21(2): 115-119, 2005.

Cabana, M.D., Slish, K.K., Nan, B., Lin, X., Clark, N. Inconsistencies in parent reports of asthma symptoms. (Submitted 2005)

Cabana, M.D., Slish, K.K., Evans, D., Mellins, R.B., Brown, R.W., Lin, X., Kaciroti, N., Clark, N.M. Impact of physician asthma care education on patient outcomes. Pediatrics, 117(6): 2149-2157, June, 2006.

Valerio, M., Cabana, M.D., White, D.F., Heidmann, D.M., Brown, R.W., Bratton, S.L. Understanding of asthma management: Medicaid parents' perspectives. Chest, 129 (3): 594-601, 2006.

Bratton, S.L., Cabana, M.D., Brown, R.W., White, D.F., Wang, Y., Lang, S.W., Clark, N.M. Asthma educational seminar targeting Medicaid providers. Respiratory Care, 51(1): 49-55, 2006.

Clark, N.M., Gong, M., Schork, M.A., Evans, D., Roloff, D., Hurwitz, M., Maiman, L., and Mellins, R.B. Impact of education for physicians on patient outcomes. Pediatrics, 101(5):831-836, May 1998.

Clark, N.M., Gong, M., Schork, M.A., Evans, D., Roloff, D., Hurwitz, M., Maiman, L., and Mellins, R.B. Long-term effects of asthma education for physicians on patient satisfaction and use of health services. European Respiratory Journal, (16):15-21, 2000.

Clark, N.M., Cabana, M. D., Nan, B., Gong Z. M., Slish, K.K., Birk, N. A., Kaciroti, N. The Clinician-Patient Partnership Paradigm: Outcomes Associated with Physician Communication Behavior. Clinical Pediatrics. 47(1): 49-57, 2008 

Project-Related Presentations: 

Clark, N.M. Addressing seasonal peaks of symptoms of asthma in children, with M.Cabana. ALA/ATS International Conference, Orlando, FL, May 2004 (poster session).

For more information, contact Noreen Clark at nmclark@umich.edu