Translation of an evidence-based asthma intervention: Physician Asthma Care Education (PACE) in the United States and Australia

  • Primary Care Respiratory Journal (2012) 22, 2936
  • doi:10.4104/pcrj.2012.00093
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Physician Asthma Care Education (PACE) is a programme developed in the USA to improve paediatric asthma outcomes.


To examine translation of PACE to Australia.


The RE-AIM framework was used to assess translation. Demographic characteristics and findings regarding clinical asthma outcomes from PACE randomised clinical trials in both countries were examined. Qualitative content analysis was used to examine fidelity to intervention components.


Both iterations of PACE reached similar target audiences (general practice physicians and paediatric patients with asthma); however, in the USA, more children with persistent disease were enrolled. In both countries, participation comprised approximately 10% of eligible physicians and 25% of patients. In both countries, PACE deployed well-known local physicians and behavioural scientists as facilitators. Sponsorship of the programme was provided by professional associations and government agencies. Fidelity to essential programme elements was observed, but PACE Australia workshops included additional components. Similar outcomes included improvements in clinician confidence in developing short-term and long-term care plans, prescribing inhaled corticosteroids, and providing written management instructions to patients. No additional time was spent in the patient visit compared with controls. US PACE realised reductions in symptoms and healthcare use, results that could not be confirmed in Australia because of limitations in follow-up time and sample sizes. US PACE is maintained through a National Heart, Lung, and Blood Institute website. Development of maintenance strategies for PACE Australia is underway.


Based on criteria of the RE-AIM framework, the US version of PACE has been successfully translated for use in Australia.

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Handling editor Hilary Pinnock

Statistical review Gopal Netuveli

The authors would like to thank Katherine Faiver (University of Michigan) and Pin-Pin Song (University of Michigan) for their assistance with formatting this manuscript, and Edward Green (University of Michigan) for statistical assistance.

Funding In Australia this work was supported by the Australian Government Department of Health and Aging, Asthma Management Program and, in the USA, by the National, Heart, Lung, and Blood Institute and the Robert Wood Johnson Foundation (Princeton, NJ).

Author information


  1. Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA

    • Minal R Patel
    • , Randall W Brown
    •  & Noreen M Clark
  2. University of Sydney, NSW, Australia

    • Smita Shah
    • , Craig Mellis
    •  & Christine Jenkins
  3. Division of General Pediatrics, University of California San Francisco, San Francisco, CA, USA

    • Michael D Cabana
  4. Centre for Adolescent Health, Royal Children's Hospital; Department of Pediatrics, The University of Melbourne; Murdoch Children's Research Institute, Melbourne, VIC, Australia

    • Susan M Sawyer
  5. Woolcock Institute of Medical Research, NSW, Australia

    • Brett Toelle


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MRP and SS contributed to study concept and design, analysis and interpretation of the data, and drafting and revision of the manuscript. MDC, SS, CM, BT, CJ, and RWB contributed to drafting and revision of the manuscript. NMC contributed to study concept and design, interpretation of the data, and drafting and revision of the manuscript.

Competing interests

SS and RWB have received research support from Astra Zeneca Pharmaceuticals. MDC and RWB have been advisors and members of the Merck Pharmaceuticals speaker's bureau. MRP, SS, CJ, BT, CM, and NMC have no conflicts of interest in relation to this article.

Corresponding author

Correspondence to Noreen M Clark.