Cultural Competency Training and Disparities Report Cards
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Harvard Vanguard Medical Associates
Eastern Massachusetts
Diabetes
Health Care System
African Americans
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PROJECT
Providers receive cultural competency training and monthly race-stratified performance reports.
Over the course of 12 months, primary care physicians, nurse practitioners and physician assistants are given tools
and training regarding racial disparities in health care. Participating clinicians attend lunchtime lectures that focus on
racial disparities in the quality of diabetes care within the Harvard Vanguard health system as well as disparities by primary
care teams. Sample race-stratified performance reports are presented for review and comment. Clinician feedback
is utilized to revise the reports. Clinicians also attend a one-day (for physicians) or two-day (for nurse practitioners
and physician assistants) cultural competency training, which includes lectures, discussions, introspective
exercises and community tours.
Following the training, clinicians receive monthly race-stratified diabetes performance feedback reports, which include patient clinical data, information about patient experience and information about organization of care; and receive monthly informational sheets on delivering culturally tailored diabetes care.
RATIONALE
The Chronic Care Model suggests that health care outcomes are linked to patient-provider interactions. Improving these interactions may lead to better health outcomes for minority patients. Positive working relationships are particularly important in diabetes care, where successful treatment is dependent upon establishment of a partnership between the patient and the clinical team.
Raising awareness among providers about racial and ethnic disparities in care is a first step, especially among those
who are not aware that such disparities may exist in their own practices. Cultural competency training may lead to better clinician-patient relationships by helping clinicians better understand social and cultural factors that influence health behaviors affecting disease management and patient outcomes.
Performance feedback can stimulate local quality improvement activities. Giving providers feedback about racial
disparities in their own practices may heighten awareness among individual clinicians, prompting efforts to improve health care for minority patients.
EVALUATION PLAN
Funded by Finding Answers in 2006.
A 12-month randomized controlled trial is being conducted. Individual primary care teams are being randomized into intervention or treatment as usual utilizing a general chronic care model. The evaluation consists of 124 physicians, nurse practitioners, and physician assistants in 31 primary care teams at eight clinics. A primary care team consists of two to three physicians working collaboratively with a nurse practitioner or physician assistant to manage a population of patients. Within both groups, a sample of patients is being randomized to measure clinical outcomes. Outcomes are being measured through clinician surveys about awareness of racial disparities in the quality of diabetes care and patient clinical outcomes of important diabetes measures (HbA1c, LDL cholesterol and blood pressure).
Principal Investigator
- Thomas D. Sequist, MD, MPH
Publications
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
Full Article (with subscription)
Physician Performance and Racial Disparities in Diabetes Mellitus Care
Arch Intern Med. 2008. 168(11):1145-1151
Full Article (with subscription)
Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care
J Gen Intern Med. 2008. 23(5): 678-684
Full Article (with subscription)
For More Information
Please Contact:
Thomas D. Sequist, MD, MPH
tsequist@partners.org
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