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.

DESIGN

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

PARTICIPANTS

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

INTERVENTION

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.

MEASUREMENTS

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).

LIMITATION

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

CONCLUSION

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.