Thomas D. Sequist, MD, MPH; Garrett M. Fitzmaurice, ScD; Richard Marshall, MD; Shimon Shaykevich, MS; Amy Marston, BA; Dana Gelb Safran, ScD; John Z. Ayanian, MD, MPP
Acknowledgment: The authors thank the patients and physicians of Harvard Vanguard Medical Associates for their participation in this study.
Grant Support: By the Robert Wood Johnson Foundation.
Potential Conflicts of Interest:Consultancies: T.D. Sequist (Aetna).
Requests for Single Reprints: Thomas D. Sequist, MD, MPH, Brigham and Women's Hospital, Division of General Medicine, 1620 Tremont Street, Boston, MA 02120; e-mail, email@example.com.
Current Author Addresses: Drs. Sequist and Fitzmaurice and Mr. Shaykevich: Brigham and Women's Hospital, Division of General Medicine, 1620 Tremont Street, Boston, MA 02120.
Dr. Marshall and Ms. Marston: Harvard Vanguard Medical Associates, Office of Clinical Research, 133 Brookline Avenue, Boston, MA 02215.
Dr. Safran: Blue Cross Blue Shield of Massachusetts, Landmark Center, 401 Park Drive, Boston, MA 02215.
Dr. Ayanian: Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115.
Author Contributions: Conception and design: T.D. Sequist, G.M. Fitzmaurice, R. Marshall, D.G. Safran, J.Z. Ayanian.
Analysis and interpretation of the data: T.D. Sequist, G.M. Fitzmaurice, R. Marshall, S. Shaykevich, A. Marston, D.G. Safran, J.Z. Ayanian.
Drafting of the article: T.D. Sequist, G.M. Fitzmaurice, A. Marston.
Critical revision of the article for important intellectual content: T.D. Sequist, G.M. Fitzmaurice, R. Marshall, S. Shaykevich, D.G. Safran, J.Z. Ayanian.
Final approval of the article: T.D. Sequist, G.M. Fitzmaurice, R. Marshall, D.G. Safran, J.Z. Ayanian.
Provision of study materials or patients: T.D. Sequist, R. Marshall.
Statistical expertise: T.D. Sequist, G.M. Fitzmaurice, S. Shaykevich.
Obtaining of funding: T.D. Sequist, R. Marshall, D.G. Safran.
Administrative, technical, or logistic support: T.D. Sequist, R. Marshall, A. Marston.
Collection and assembly of data: T.D. Sequist, A. Marston.
Sequist TD, Fitzmaurice GM, Marshall R, Shaykevich S, Marston A, Safran DG, et al. Cultural Competency Training and Performance Reports to Improve Diabetes Care for Black Patients: A Cluster Randomized, Controlled Trial. Ann Intern Med. 2010;152:40-46. doi: 10.7326/0003-4819-152-1-201001050-00009
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Published: Ann Intern Med. 2010;152(1):40-46.
Increasing clinician awareness of racial disparities and improving communication may enhance diabetes care among black patients.
To evaluate the effect of cultural competency training and performance feedback for primary care clinicians on diabetes care for black patients.
Cluster randomized, controlled trial conducted between June 2007 and May 2008. (ClinicalTrials.gov registration number: NCT00436176)
8 ambulatory health centers in eastern Massachusetts.
124 primary care clinicians caring for 2699 (36%) black and 4858 (64%) white diabetic patients.
Intervention clinicians received cultural competency training and monthly race-stratified performance reports that highlighted racial differences in control of hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL) cholesterol levels and blood pressure.
Clinician awareness of racial differences in diabetes care and rates of achieving clinical control targets among black patients at 12 months.
White and black patients differed significantly in baseline rates of achieving an HbA1c 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 PÂ < 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%; PÂ = 0.003), within their local health center (70% vs. 51%; PÂ = 0.020), and among their own patients (63% vs. 43%; PÂ = 0.037). Black patients of clinicians in the intervention and control groups did not differ at 12 months in rates of controlling HbA1c level (48% vs. 45%; PÂ = 0.24), LDL cholesterol level (48% vs. 49%; PÂ = 0.40), or blood pressure (23% vs. 25%; PÂ = 0.47).
11% of primary care teams did not attend cultural competency training sessions.
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.
Robert Wood Johnson Foundation.
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Cardiology, Endocrine and Metabolism, Diabetes, Coronary Risk Factors.
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