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


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


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


METHODS
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.


METHODS
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).


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


CONCLUSIONS
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.
Sequist
Thomas D
TD
Division of General Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA. tsequist@partners.org
Fitzmaurice
Garrett M
GM
Marshall
Richard
R
Shaykevich
Shimon
S
Marston
Amy
A
Safran
Dana Gelb
DG
Ayanian
John Z
JZ
D001741:Black or African American; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D054521:Cultural Competency; D003920:Diabetes Mellitus / Q000097:blood / Q000208:ethnology*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008404:Massachusetts; D009722:Nurse Practitioners / Q000193:education; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010823:Physician Assistants / Q000193:education; D010821:Physicians, Family / Q000193:education*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin