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Project Description

Many large health care systems are adopting components of the Chronic Care Model (CCM) to achieve substantial gains in diabetes care. Harvard Vanguard Medical Associates (HVMA) is a large, integrated health care delivery system in eastern Massachusetts that has implemented the CCM. This project will use a randomized, controlled study design within HVMA to evaluate whether enhancements to the CCM can produce significant improvement in the quality of diabetes care for Black patients. Intervention clinicians will receive bimonthly panel-level disparities report cards, health navigation training, and cultural competency training.  The study will occur over a 12 month period and involve 4,000 White patients and 2,500 Black patients with diabetes who are receiving care at 8 health centers. The primary outcomes will include rates of glucose (HbA1c <7.0), LDL cholesterol (<100 mg/dL), and blood pressure (<130/80) control.  Using patient focus groups, this program will identify significant barriers to care and guide health navigation training. Clinicians will be surveyed pre- and post-intervention to assess the effect of the intervention on knowledge and attitudes towards health disparities. Patient experiences will be assessed pre- and post-intervention using a validated instrument to determine whether the intervention can reduce existing racial disparities in patient reports of quality. HVMA will perform a cost analysis related to the intervention using a health system perspective.

Principal Investigator
Thomas D. Sequist, MD, MPH

Lead Organization
Harvard Vanguard Medical Associates

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