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 uses 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 are receiving bimonthly panel-level disparities report cards, health navigation training, and cultural competency training, while control clinicians are functioning within the context of the generic Chronic Care Model. The study is occurring over a 12-month period and involves 4,000 white patients and 2,500 black patients with diabetes receiving care at eight health centers.

The primary outcomes include rates of glucose (HbA1c <7.0), LDL cholesterol (<100 mg/dL), and blood pressure (<130/80) control. We used patient focus groups to identify significant barriers to care and guide health navigation training. We are surveying clinicians pre- and postintervention to assess the effect of the intervention on knowledge and attitudes toward disparities. Patient experiences are being assessed pre- and postintervention using a validated instrument to determine whether the intervention can reduce existing racial disparities in patient reports of quality. At the completion of the intervention, we will perform a cost analysis related to the intervention using a health system perspective.