Improving Diabetes Care for African Americans

Study Overview
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Brief Summary
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The goal of this study is to investigate methods of improving diabetes care for African Americans in primary care clinics. Primary care clinicians will receive training in the delivery of cross-cultural medicine as well as regular performance feedback reports.

Detailed Description
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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. We have previously identified racial disparities in key diabetes outcomes 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 monthly 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 black patients with diabetes 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. We will use patient focus groups to identify significant barriers to care and guide health navigation training. We will survey clinicians 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. We will perform a cost analysis related to the intervention using a health system perspective. 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.

Official Title
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The Expanded Chronic Care Model: Targeting Disparities in Diabetes Care

Conditions
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Diabetes

Intervention / Treatment
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* Behavioral: Expanded Chronic Care Model


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of diabetes mellitus (based on fasting glucose, HbA1c, and problem list) At least 18 years old At least one face-to-face visit with Harvard Vanguard primary care clinician in the last 2 years Exclusion Criteria: Any patient not categorized as either White or Black based on race identifier in the electronic medical record

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Intervention clinicians receive monthly performance reports, cultural competency training, and health navigation training | Behavioral: Expanded Chronic Care Model<br>* Intervention clinicians receive monthly performance feedback reports, cultural competency training, and health navigation training.<br>|
| No Intervention: 2<br>Control clinicians function within the context of the generic chronic care model. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of LDL cholesterol control (< 100 mg/dL) |  | 12 months | 
| Rate of blood pressure control (< 130/80 mmHg) |  | 12 months | 
| Rate of HbA1c control (<7%) |  | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of HbA1c control (<8%) |  | 12 months | 
| Rate of LDL cholesterol control (< 130 mg/dL) |  | 12 months | 
| Rate of blood pressure control (< 140/90 mmHg) |  | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes mellitus, Quality of Health Care, Cultural Competency, Performance Feedback, Health navigator, Health disparities, Racial disparities