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.
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.
Duru
O Kenrik
OK
David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA. kduru@mednet.ucla.edu
Mangione
Carol M
CM
Steers
Neil W
NW
Herman
William H
WH
Karter
Andrew J
AJ
Kountz
David
D
Marrero
David G
DG
Safford
Monika M
MM
Waitzfelder
Beth
B
Gerzoff
Robert B
RB
Huh
Soonim
S
Brown
Arleen F
AF
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