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 G. Marrero, Monika M. Safford, Beth Waitzfelder, Robert B. Gerzoff, Soonim Huh, Arleen F. Brown

Research output: Contribution to journalArticle

24 Scopus citations

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 (US)
Pages (from-to)1121-1128
Number of pages8
JournalMedical care
Volume44
Issue number12
DOIs
StatePublished - Dec 1 2006

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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

Duru, O. K., Mangione, C. M., Steers, N. W., Herman, W. H., Karter, A. J., Kountz, D., Marrero, D. G., Safford, M. M., Waitzfelder, B., Gerzoff, R. B., Huh, S., & Brown, A. F. (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, 44(12), 1121-1128. https://doi.org/10.1097/01.mlr.0000237423.05294.c0