Cultural competency training and performance reports to improve diabetes care for black patients: a cluster randomized, controlled trial

Thomas D Sequist, Garrett M Fitzmaurice, Richard Marshall, Shimon Shaykevich, Amy Marston, Dana Gelb Safran, John Z Ayanian
Annals of Internal Medicine 2010 January 5, 152 (1): 40-6

BACKGROUND: Increasing clinician awareness of racial disparities and improving communication may enhance diabetes care among black patients.

OBJECTIVE: To evaluate the effect of cultural competency training and performance feedback for primary care clinicians on diabetes care for black patients.

DESIGN: Cluster randomized, controlled trial conducted between June 2007 and May 2008. ( registration number: NCT00436176) SETTING: 8 ambulatory health centers in eastern Massachusetts.

PARTICIPANTS: 124 primary care clinicians caring for 2699 (36%) black and 4858 (64%) white diabetic patients.

INTERVENTION: INTERVENTION clinicians received cultural competency training and monthly race-stratified performance reports that highlighted racial differences in control of hemoglobin A(1c) (HbA(1c)) and low-density lipoprotein (LDL) cholesterol levels and blood pressure.

MEASUREMENTS: Clinician awareness of racial differences in diabetes care and rates of achieving clinical control targets among black patients at 12 months.

RESULTS: White and black patients differed significantly in baseline rates of achieving an HbA(1c) level less than 7% (46% vs. 40%), an LDL cholesterol level less than 2.59 mmol/L (<100 mg/dL) (55% vs. 43%), and blood pressure less than 130/80 mm Hg (32% vs. 24%) (all P < 0.050). At study completion, intervention clinicians were significantly more likely than control clinicians to acknowledge the presence of racial disparities in the 8 health centers as a whole (82% vs. 59%; P = 0.003), within their local health center (70% vs. 51%; P = 0.020), and among their own patients (63% vs. 43%; P = 0.037). Black patients of clinicians in the intervention and control groups did not differ at 12 months in rates of controlling HbA(1c) level (48% vs. 45%; P = 0.24), LDL cholesterol level (48% vs. 49%; P = 0.40), or blood pressure (23% vs. 25%; P = 0.47).

LIMITATION: 11% of primary care teams did not attend cultural competency training sessions.

CONCLUSION: The combination of cultural competency training and race-stratified performance reports increased clinician awareness of racial disparities in diabetes care but did not improve clinical outcomes among black patients.

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