Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Sep-Oct;103(9-10):968-77.
doi: 10.1016/s0027-9684(15)30454-5.

Clinicians' views of an intervention to reduce racial disparities in diabetes outcomes

Ruth Thorlby  1 , Selena Jorgensen, John Z Ayanian, Thomas D Sequist
Affiliations
Randomized Controlled Trial

Clinicians' views of an intervention to reduce racial disparities in diabetes outcomes

Ruth Thorlby et al. J Natl Med Assoc. 2011 Sep-Oct.

Abstract

Rationale: Interventions that improve clinicians' awareness of racial disparities and improve their communication skills are considered promising strategies for reducing disparities in health care. We report clinicians' views of an intervention involving cultural competency training and race-stratified performance reports designed to reduce racial disparities in diabetes outcomes.

Research design and methods: Semistructured interviews were conducted with 12 physicians and 5 nurse practitioners who recently participated in a randomized intervention to reduce racial disparities in diabetes outcomes. Clinicians were asked open-ended questions about their attitudes towards the intervention, the causes of disparities, and potential solutions to them.

Results: Thematic analysis of the interviews showed that most clinicians acknowledged the presence of racial disparities in diabetes control among their patients. They described a complex set of causes, including socioeconomic factors, but perceived only some causes to be within their power to change, such as switching patients to less-expensive generic drugs. The performance reports and training were generally well received but some clinicians did not feel empowered to act on the information. All clinicians identified additional services that would help them address disparities; for example, culturally tailored nutrition advice. Some clinicians challenged the premise of the intervention, focusing instead on socioeconomic factors as the primary cause of disparities rather than on patients' race.

Conclusions: The cultural competency training and performance reports were well received by many but not all of the clinicians. Clinicians reported the intervention alone had not empowered them to address the complex, root causes of racial disparities in diabetes outcomes.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Conceptual model of quality of care and outcomes by race, ethnicity, language and socioeconomic factors, adapted from Ayanian JZ, Determinants of racial and ethnic disparities in surgical care. World J Surg. 2008 32:509-515
Figure 2
Figure 2
Example of physician-level clinical performance feedback report
Figure 3
Figure 3
Example of supplementary sheet for clinicians
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med. 2005;353(7):692–700. - PubMed
    1. Sequist TD, Adams A, Zhang F, Ross-Degnan D, Ayanian JZ. Effect of quality improvement on racial disparities in diabetes care. Arch Intern Med. 2006;66(6):675–681. - PubMed
    1. McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of medicare coverage. Ann Intern Med. 2009;150(8):505–515. - PubMed
    1. Jones RG, Trivedi AN, Ayanian JZ. Factors influencing the effectiveness of interventions to reduce racial and ethnic disparities in health care. Soc Sci Med. 2010;70(3):337–341. - PMC - PubMed
    1. Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64(Suppl 5):101–156. - PMC - PubMed

Publication types

MeSH terms