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.