Cultural Competency Training and Performance Reports to Improve Diabetes Care for Black Patients

A Cluster Randomized, Controlled Trial

Increasing clinician awareness of racial disparities and improving communication may enhance diabetes care among Black patients. This study evaluated the effect of cultural competency training and performance feedback for primary care clinicians on diabetes care for Back patients.

Eight ambulatory health centers in eastern Massachusetts were part of a cluster randomized, controlled trial conducted between June 2007 and May 2008. Participants included 124 primary care clinicians caring for 2,699 (36%) Black and 4,858 (64%) White diabetic patients. Intervention clinicians received cultural competency training and monthly race-stratified performance reports that highlighted racial differences in control of hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL) cholesterol levels and blood pressure. This study measured clinician awareness of racial differences in diabetes care and rates of achieving clinical control targets among Black patients at 12 months.

White and Black patients differed significantly in baseline rates of achieving an HbA1c level less than 7 percent, an LDL cholesterol level less than 2.59 mmol/L (<100 mg/dL), and blood pressure less than 130/80 mm Hg. At study completion, intervention clinicians were significantly more likely than control clinicians to acknowledge the presence of racial disparities in the eight health centers as a whole, within their local health center, and among their own patients. Black patients of clinicians in the intervention and control groups did not differ at 12 months in rates of controlling HbA1c level, LDL cholesterol level, or blood pressure.

The study concluded that 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.