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Ann Intern Med. 2010 Jan 5;152(1):40-6. doi: 10.7326/0003-4819-152-1-201001050-00009.

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

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  • 1Division of General Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA. tsequist@partners.org

Abstract

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. (ClinicalTrials.gov 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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PMID:
20048271
[PubMed - indexed for MEDLINE]
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