title: Reducing racial/ethnic disparities in diabetes: the Coached Care (R2D2C2) project.
abstract: BACKGROUND
  Despite numerous efforts to change healthcare delivery, the profile of disparities in diabetes care and outcomes has not changed substantially over the past decade.
  
  
  OBJECTIVE
  To understand potential contributors to disparities in diabetes care and glycemic control.
  
  
  METHODS
  Cross sectional analysis.
  
  
  METHODS
  Seven outpatient clinics affiliated with an academic medical center.
  
  
  METHODS
  Adult patients with type 2 diabetes who were Mexican American, Vietnamese American or non-Hispanic white (n = 1,484).
  
  
  METHODS
  Glycemic control was measured as hemoglobin A1c (HbA1c) level. Patient, provider and system characteristics included demographic characteristics; access to care; quality of process of care including clinical inertia; quality of interpersonal care; illness burden; mastery (diabetes management confidence, passivity); and adherence to treatment.
  
  
  RESULTS
  Unadjusted HbA1c values were significantly higher for Mexican American patients (n = 782) (mean = 8.3 % [SD:2.1]) compared with non-Hispanic whites (n = 389) (mean = 7.1 % [SD:1.4]). There were no significant differences in HbA1c values between Vietnamese American and non-Hispanic white patients. There were no statistically significant group differences in glycemic control after adjustment for multiple measures of access, and quality of process and interpersonal care. Disease management mastery and adherence to treatment were related to glycemic control for all patients, independent of race/ethnicity.
  
  
  CONCLUSIONS
  Generalizability to other minorities or to patients with poorer access to care may be limited.
  
  
  CONCLUSIONS
  The complex interplay among patient, physician and system characteristics contributed to disparities in HbA1c between Mexican American and non-Hispanic white patients. In contrast, Vietnamese American patients achieved HbA1c levels comparable to non-Hispanic whites and adjustment for numerous characteristics failed to identify confounders that could have masked disparities in this subgroup. Disease management mastery appeared to be an important contributor to glycemic control for all patient subgroups.
authors: Health Policy Research Institute and Department of Medicine, School of Medicine, University of California, Irvine, 100 Theory Suite 110, Irvine, CA, 92697, USA, skaplan@uci.edu.
authors: Sherrie H
authors: SH
authors: Kaplan
authors: John
authors: J
authors: Billimek
authors: Dara H
authors: DH
authors: Sorkin
authors: Quyen
authors: Q
authors: Ngo-Metzger
authors: Sheldon
authors: S
authors: Greenfield
mesh_terms: D000328:Adult; D000368:Aged; D001213:Asian / Q000523:psychology / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D015438:Health Behavior / Q000208:ethnology; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D017058:Mexican Americans / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D011787:Quality of Health Care; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
references: Med Care. 1995 Dec;33(12):1176-87
references: 7500658
references: Diabetes Care. 2011 Jan;34 Suppl 1:S11-61
references: 21193625
references: Diabetes Care. 1994 Jun;17 Suppl 1:32-9
references: 8088221
references: Diabetes Care. 2007 Apr;30(4):807-12
references: 17259469
references: JAMA. 2004 Jan 21;291(3):335-42
references: 14734596
references: Health Psychol. 2004 Mar;23(2):119-25
references: 15008654
references: JAMA. 1998 Jun 3;279(21):1703-8
references: 9624022
references: Med Care. 1992 Jun;30(6):473-83
references: 1593914
references: Med Care. 2010 Jun;48(6 Suppl):S9-16
references: 20473205
references: N Engl J Med. 2005 Aug 18;353(7):692-700
references: 16107622
references: Arch Intern Med. 2006 Sep 25;166(17):1836-41
references: 17000939
references: Med Care. 2004 Sep;42(9):829-39
references: 15319608
references: Diabetes Care. 2008 May;31(5):916-21
references: 18235050
references: Diabetes Care. 2002 Jun;25(6):1015-21
references: 12032108
references: Arch Intern Med. 2006 Sep 25;166(17):1829-35
references: 17000938
references: Med Care Res Rev. 2007 Oct;64(5 Suppl):101S-56S
references: 17881626
references: Fam Pract. 2002 Oct;19(5):476-83
references: 12356698
references: Ann Intern Med. 2004 Aug 17;141(4):272-81
references: 15313743
references: BMJ. 1995 Jan 21;310(6973):170
references: 7833759
references: Diabetes Care. 1999 Nov;22(11):1790-5
references: 10546009
references: Patient Educ Couns. 2009 Dec;77(3):404-12
references: 19892508
references: Patient Educ Couns. 2011 Nov;85(2):286-9
references: 20971603
references: Health Psychol. 2009 Jan;28(1):48-55
references: 19210017
references: Med Care. 1999 May;37(5):510-7
references: 10335753
references: J Gen Intern Med. 2007 Nov;22 Suppl 2:324-30
references: 17957419
references: Ann Allergy Asthma Immunol. 2001 Mar;86(3):263-71
references: 11289322
references: Ann Intern Med. 1998 Sep 1;129(5):406-11
references: 9735069
references: Diabetes Care. 2001 Mar;24(3):454-9
references: 11289467
references: Am J Public Health. 2003 Oct;93(10):1713-9
references: 14534227
references: Health Aff (Millwood). 2011 Oct;30(10):1921-9
references: 21976336
references: Acad Med. 1999 Feb;74(2):195-8
references: 10065061
references: Ann Fam Med. 2010 Sep-Oct;8(5):410-7
references: 20843882
references: Arch Fam Med. 2000 Nov-Dec;9(10):1156-63
references: 11115223
references: Med Care. 1998 May;36(5):728-39
references: 9596063
references: JAMA. 1999 Aug 11;282(6):583-9
references: 10450723
references: JAMA. 2004 Oct 13;292(14):1711-6
references: 15479936
references: Ann Intern Med. 2004 Jun 1;140(11):887-96
references: 15172903
references: Health Psychol. 2008 Nov;27(6):728-36
references: 19025268
references: Diabet Med. 2005 Oct;22(10):1379-85
references: 16176200
references: Diabetes Educ. 2005 Mar-Apr;31(2):240-50
references: 15797853
references: Ann Intern Med. 2002 Jan 15;136(2):111-21
references: 11790062
references: Health Serv Res. 2012 Jun;47(3 Pt 2):1232-54
references: 22353147
references: JAMA. 2006 Oct 25;296(16):1998-2004
references: 17062863
references: J Health Soc Behav. 2005 Sep;46(3):274-88
references: 16259149
references: Am J Public Health. 2004 Dec;94(12):2084-90
references: 15569958
references: Health Aff (Millwood). 2002 Mar-Apr;21(2):60-76
references: 11900187
references: J Gen Intern Med. 2002 Apr;17(4):243-52
references: 11972720
references: JAMA. 2006 Jul 26;296(4):427-40
references: 16868301
references: Health Aff (Millwood). 2011 Oct;30(10):1880-7
references: 21976330
references: Am J Health Promot. 1996 Mar-Apr;10(4):282-98
references: 10159709
references: Epidemiol Rev. 2004;26:63-77
references: 15234948
references: N Engl J Med. 2003 Jun 26;348(26):2635-45
references: 12826639
references: Ann Intern Med. 1996 Mar 1;124(5):497-504
references: 8602709
references: Diabetes Care. 2011 May;34(5):1180-2
references: 21464464
references: Am J Manag Care. 2005 Aug;11(8):478-88
references: 16095434
references: J Behav Med. 1997 Jun;20(3):291-312
references: 9212382
references: J Behav Med. 1992 Oct;15(5):447-68
references: 1447757
references: Med Care. 2008 Apr;46(4):444-8
references: 18362826
references: JAMA. 2002 Jul 24-31;288(4):475-82
references: 12132978