title: The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care: the Translating Research Into Action for Diabetes (TRIAD) Study.
abstract: OBJECTIVE
  We sought to determine whether greater implementation of clinical care strategies in managed care is associated with attenuation of known racial/ethnic disparities in diabetes care.
  
  
  METHODS
  Using cross-sectional data, we examined the quality of diabetes care as measured by frequencies of process delivery as well as medication management of intermediate outcomes, for 7426 black, Latinos, Asian/Pacific Islanders, and white participants enrolled in 10 managed care plans within 63 provider groups. We stratified models by intensity of 3 clinical care strategies at the provider group level: physician reminders, physician feedback, or use of a diabetes registry.
  
  
  RESULTS
  Exposure to clinical care strategy implementation at the provider group level varied by race and ethnicity, with <10% of black participants enrolled in provider groups in the highest-intensity quintile for physician feedback and <10% of both black and Asian/Pacific Islander participants enrolled in groups in the highest-intensity quintile for diabetes registry use. Although disparities in care were confirmed, particularly for black relative to white subjects, we did not find a consistent pattern of disparity attenuation with increasing implementation intensity for either processes of care or medication management of intermediate outcomes.
  
  
  CONCLUSIONS
  For the most part, high-intensity implementation of a diabetes registry, physician feedback, or physician reminders, 3 clinical care strategies similar to those used in many health care settings, are not associated with attenuation of known disparities of diabetes care in managed care.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA. kduru@mednet.ucla.edu
authors.forename: O Kenrik
authors.initials: OK
authors.lastname: Duru
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.forename: Neil W
authors.initials: NW
authors.lastname: Steers
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: David
authors.initials: D
authors.lastname: Kountz
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
authors.forename: Robert B
authors.initials: RB
authors.lastname: Gerzoff
authors.forename: Soonim
authors.initials: S
authors.lastname: Huh
authors.forename: Arleen F
authors.initials: AF
authors.lastname: Brown
mesh_terms: D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy*; D019468:Disease Management; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008875:Middle Aged; D011787:Quality of Health Care / Q000458:organization & administration; D012042:Registries; D017010:Reminder Systems