The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care: The Translating Research into Action for Diabetes (TRIAD) study

O. Kenrik Duru, Carol M. Mangione, Neil W. Steers, William H. Herman, Andrew J. Karter, David Kountz, David Marrero, Monika M. Safford, Beth Waitzfelder, Robert B. Gerzoff, Soonim Huh, Arleen F. Brown

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

OBJECTIVE: We sought to determine whether greater implementation of clinical care strategies in managed care is associated with attenuation of known racial/ethnic disparities in diabetes care. RESEARCH DESIGN AND METHODS: Using cross-sectional data, we examined the quality of diabetes care as measured by frequencies of process delivery as well as medication management of intermediate outcomes, for 7426 black, Latinos, Asian/Pacific Islanders, and white participants enrolled in 10 managed care plans within 63 provider groups. We stratified models by intensity of 3 clinical care strategies at the provider group level: physician reminders, physician feedback, or use of a diabetes registry. RESULTS: Exposure to clinical care strategy implementation at the provider group level varied by race and ethnicity, with <10% of black participants enrolled in provider groups in the highest-intensity quintile for physician feedback and <10% of both black and Asian/Pacific Islander participants enrolled in groups in the highest-intensity quintile for diabetes registry use. Although disparities in care were confirmed, particularly for black relative to white subjects, we did not find a consistent pattern of disparity attenuation with increasing implementation intensity for either processes of care or medication management of intermediate outcomes. CONCLUSIONS: For the most part, high-intensity implementation of a diabetes registry, physician feedback, or physician reminders, 3 clinical care strategies similar to those used in many health care settings, are not associated with attenuation of known disparities of diabetes care in managed care.

Original languageEnglish
Pages (from-to)1121-1128
Number of pages8
JournalMedical Care
Volume44
Issue number12
DOIs
StatePublished - Dec 2006

Fingerprint

chronic illness
Physicians
Managed Care Programs
Registries
Research
physician
managed care
Quality of Health Care
Group
Hispanic Americans
medication
Research Design
Delivery of Health Care
management
research planning
research method
ethnicity
health care

Keywords

  • Chronic disease
  • Diabetes
  • Quality improvement
  • Quality of care
  • Race and ethnicity

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care : The Translating Research into Action for Diabetes (TRIAD) study. / Duru, O. Kenrik; Mangione, Carol M.; Steers, Neil W.; Herman, William H.; Karter, Andrew J.; Kountz, David; Marrero, David; Safford, Monika M.; Waitzfelder, Beth; Gerzoff, Robert B.; Huh, Soonim; Brown, Arleen F.

In: Medical Care, Vol. 44, No. 12, 12.2006, p. 1121-1128.

Research output: Contribution to journalArticle

Duru, OK, Mangione, CM, Steers, NW, Herman, WH, Karter, AJ, Kountz, D, Marrero, D, Safford, MM, Waitzfelder, B, Gerzoff, RB, Huh, S & Brown, AF 2006, 'The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care: The Translating Research into Action for Diabetes (TRIAD) study', Medical Care, vol. 44, no. 12, pp. 1121-1128. https://doi.org/10.1097/01.mlr.0000237423.05294.c0
Duru, O. Kenrik ; Mangione, Carol M. ; Steers, Neil W. ; Herman, William H. ; Karter, Andrew J. ; Kountz, David ; Marrero, David ; Safford, Monika M. ; Waitzfelder, Beth ; Gerzoff, Robert B. ; Huh, Soonim ; Brown, Arleen F. / The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care : The Translating Research into Action for Diabetes (TRIAD) study. In: Medical Care. 2006 ; Vol. 44, No. 12. pp. 1121-1128.
@article{9ad292c9874749a39b1b7ef235ff48ab,
title = "The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care: The Translating Research into Action for Diabetes (TRIAD) study",
abstract = "OBJECTIVE: We sought to determine whether greater implementation of clinical care strategies in managed care is associated with attenuation of known racial/ethnic disparities in diabetes care. RESEARCH DESIGN AND METHODS: Using cross-sectional data, we examined the quality of diabetes care as measured by frequencies of process delivery as well as medication management of intermediate outcomes, for 7426 black, Latinos, Asian/Pacific Islanders, and white participants enrolled in 10 managed care plans within 63 provider groups. We stratified models by intensity of 3 clinical care strategies at the provider group level: physician reminders, physician feedback, or use of a diabetes registry. RESULTS: Exposure to clinical care strategy implementation at the provider group level varied by race and ethnicity, with <10{\%} of black participants enrolled in provider groups in the highest-intensity quintile for physician feedback and <10{\%} of both black and Asian/Pacific Islander participants enrolled in groups in the highest-intensity quintile for diabetes registry use. Although disparities in care were confirmed, particularly for black relative to white subjects, we did not find a consistent pattern of disparity attenuation with increasing implementation intensity for either processes of care or medication management of intermediate outcomes. CONCLUSIONS: For the most part, high-intensity implementation of a diabetes registry, physician feedback, or physician reminders, 3 clinical care strategies similar to those used in many health care settings, are not associated with attenuation of known disparities of diabetes care in managed care.",
keywords = "Chronic disease, Diabetes, Quality improvement, Quality of care, Race and ethnicity",
author = "Duru, {O. Kenrik} and Mangione, {Carol M.} and Steers, {Neil W.} and Herman, {William H.} and Karter, {Andrew J.} and David Kountz and David Marrero and Safford, {Monika M.} and Beth Waitzfelder and Gerzoff, {Robert B.} and Soonim Huh and Brown, {Arleen F.}",
year = "2006",
month = "12",
doi = "10.1097/01.mlr.0000237423.05294.c0",
language = "English",
volume = "44",
pages = "1121--1128",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care

T2 - The Translating Research into Action for Diabetes (TRIAD) study

AU - Duru, O. Kenrik

AU - Mangione, Carol M.

AU - Steers, Neil W.

AU - Herman, William H.

AU - Karter, Andrew J.

AU - Kountz, David

AU - Marrero, David

AU - Safford, Monika M.

AU - Waitzfelder, Beth

AU - Gerzoff, Robert B.

AU - Huh, Soonim

AU - Brown, Arleen F.

PY - 2006/12

Y1 - 2006/12

N2 - OBJECTIVE: We sought to determine whether greater implementation of clinical care strategies in managed care is associated with attenuation of known racial/ethnic disparities in diabetes care. RESEARCH DESIGN AND METHODS: Using cross-sectional data, we examined the quality of diabetes care as measured by frequencies of process delivery as well as medication management of intermediate outcomes, for 7426 black, Latinos, Asian/Pacific Islanders, and white participants enrolled in 10 managed care plans within 63 provider groups. We stratified models by intensity of 3 clinical care strategies at the provider group level: physician reminders, physician feedback, or use of a diabetes registry. RESULTS: Exposure to clinical care strategy implementation at the provider group level varied by race and ethnicity, with <10% of black participants enrolled in provider groups in the highest-intensity quintile for physician feedback and <10% of both black and Asian/Pacific Islander participants enrolled in groups in the highest-intensity quintile for diabetes registry use. Although disparities in care were confirmed, particularly for black relative to white subjects, we did not find a consistent pattern of disparity attenuation with increasing implementation intensity for either processes of care or medication management of intermediate outcomes. CONCLUSIONS: For the most part, high-intensity implementation of a diabetes registry, physician feedback, or physician reminders, 3 clinical care strategies similar to those used in many health care settings, are not associated with attenuation of known disparities of diabetes care in managed care.

AB - OBJECTIVE: We sought to determine whether greater implementation of clinical care strategies in managed care is associated with attenuation of known racial/ethnic disparities in diabetes care. RESEARCH DESIGN AND METHODS: Using cross-sectional data, we examined the quality of diabetes care as measured by frequencies of process delivery as well as medication management of intermediate outcomes, for 7426 black, Latinos, Asian/Pacific Islanders, and white participants enrolled in 10 managed care plans within 63 provider groups. We stratified models by intensity of 3 clinical care strategies at the provider group level: physician reminders, physician feedback, or use of a diabetes registry. RESULTS: Exposure to clinical care strategy implementation at the provider group level varied by race and ethnicity, with <10% of black participants enrolled in provider groups in the highest-intensity quintile for physician feedback and <10% of both black and Asian/Pacific Islander participants enrolled in groups in the highest-intensity quintile for diabetes registry use. Although disparities in care were confirmed, particularly for black relative to white subjects, we did not find a consistent pattern of disparity attenuation with increasing implementation intensity for either processes of care or medication management of intermediate outcomes. CONCLUSIONS: For the most part, high-intensity implementation of a diabetes registry, physician feedback, or physician reminders, 3 clinical care strategies similar to those used in many health care settings, are not associated with attenuation of known disparities of diabetes care in managed care.

KW - Chronic disease

KW - Diabetes

KW - Quality improvement

KW - Quality of care

KW - Race and ethnicity

UR - http://www.scopus.com/inward/record.url?scp=33751351067&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33751351067&partnerID=8YFLogxK

U2 - 10.1097/01.mlr.0000237423.05294.c0

DO - 10.1097/01.mlr.0000237423.05294.c0

M3 - Article

C2 - 17122717

AN - SCOPUS:33751351067

VL - 44

SP - 1121

EP - 1128

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 12

ER -