The Foundation's initiative, Finding Answers: Disparities Research for Change, was designed to use research and evaluation to test hypothetical solutions for reducing racial and ethnic disparities in health care settings and actual disparity reduction outcomes in ongoing programs.Effective solutions are needed to address the parallel persistence of a quality chasm and racial disparities in diabetes care. Many large health care systems are adopting components of the Chronic Care Model to achieve substantial gains in diabetes care, though few health systems have successfully incorporated elements specific to minority health. Racial disparities have been previously identified in key diabetes outcome measures within an integrated health care delivery system, Harvard Vanguard Medical Associates (HVMA). This project will use a randomized, controlled study design within HVMA to evaluate whether enhancements to the Chronic Care Model 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, while control clinicians will function within the context of the generic Chronic Care Model. The study will occur over a 12-month period and involve 4,000 white patients and 2,500 African American patients with diabetes receiving care at eight health centers. The primary outcomes will include rates of glucose (HbA1c <7.0), LDL cholesterol (<100 mg/dL) and blood pressure (<130/80) control. Patient focus groups will be conducted to 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 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. A cost analysis related to the intervention using a health system perspective will be performed. In summary, this project will provide health systems with a rigorous analysis of a defined set of tools to improve diabetes care for minority populations.
Amount Awarded $295,454.00
Awarded on: 11/27/2006
Time frame: 12/1/2006 - 5/31/2009
Grant Number: 59751