Division of General Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
Ann Intern Med. 2010 Jan 5;152(1):40-6. doi: 10.7326/0003-4819-152-1-201001050-00009.
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) SETTING: 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 A(1c) (HbA(1c)) 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 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).
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.
提高临床医生对种族差异的认识并改善沟通，可能会改善黑人患者的糖尿病护理。
评估针对初级保健临床医生的文化能力培训和绩效反馈对黑人患者糖尿病护理的影响。
2007 年 6 月至 2008 年 5 月进行的群组随机对照试验。（ClinicalTrials.gov 注册号：NCT00436176）
马萨诸塞州东部的 8 个门诊医疗中心。
124 名照顾 2699 名（36%）黑人患者和 4858 名（64%）白人糖尿病患者的初级保健临床医生。
干预组临床医生接受了文化能力培训，并每月收到按种族分层的绩效报告，突出显示血红蛋白 A1c（HbA1c）和低密度脂蛋白（LDL）胆固醇水平以及血压控制方面的种族差异。
12 个月时，临床医生对糖尿病护理中种族差异的认识以及黑人患者达到临床控制目标的比率。
白人患者和黑人患者在实现 HbA1c 水平<7%（46%比 40%）、LDL 胆固醇水平<2.59mmol/L（<100mg/dL）（55%比 43%）和血压<130/80mmHg（32%比 24%）的目标方面存在显著差异（均 P<0.050）。在研究结束时，干预组临床医生比对照组临床医生更有可能承认 8 个医疗中心整体（82%比 59%；P=0.003）、其当地医疗中心（70%比 51%；P=0.020）和他们自己的患者中存在种族差异（63%比 43%；P=0.037）。干预组和对照组的黑人患者在 12 个月时控制 HbA1c 水平的比率（48%比 45%；P=0.24）、LDL 胆固醇水平（48%比 49%；P=0.40）或血压（23%比 25%；P=0.47）无显著差异。
11%的初级保健团队未参加文化能力培训课程。
文化能力培训和按种族分层的绩效报告相结合提高了临床医生对糖尿病护理中种族差异的认识，但并未改善黑人患者的临床结局。
