Journal of General Internal Medicine

, Volume 28, Issue 10, pp 1340–1349

Reducing Racial/Ethnic Disparities in Diabetes: The Coached Care (R2D2C2) Project

  • Sherrie H. Kaplan
  • John Billimek
  • Dara H. Sorkin
  • Quyen Ngo-Metzger
  • Sheldon Greenfield
Original Research

DOI: 10.1007/s11606-013-2452-y

Cite this article as:
Kaplan, S.H., Billimek, J., Sorkin, D.H. et al. J GEN INTERN MED (2013) 28: 1340. doi:10.1007/s11606-013-2452-y

ABSTRACT

BACKGROUND

Despite numerous efforts to change healthcare delivery, the profile of disparities in diabetes care and outcomes has not changed substantially over the past decade.

OBJECTIVE

To understand potential contributors to disparities in diabetes care and glycemic control.

DESIGN

Cross sectional analysis.

SSETTING

Seven outpatient clinics affiliated with an academic medical center.

PATIENTS

Adult patients with type 2 diabetes who were Mexican American, Vietnamese American or non-Hispanic white (n = 1,484).

MEASUREMENTS

Glycemic control was measured as hemoglobin A1c (HbA1c) level. Patient, provider and system characteristics included demographic characteristics; access to care; quality of process of care including clinical inertia; quality of interpersonal care; illness burden; mastery (diabetes management confidence, passivity); and adherence to treatment.

RESULTS

Unadjusted HbA1c values were significantly higher for Mexican American patients (n = 782) (mean = 8.3 % [SD:2.1]) compared with non-Hispanic whites (n = 389) (mean = 7.1 % [SD:1.4]). There were no significant differences in HbA1c values between Vietnamese American and non-Hispanic white patients. There were no statistically significant group differences in glycemic control after adjustment for multiple measures of access, and quality of process and interpersonal care. Disease management mastery and adherence to treatment were related to glycemic control for all patients, independent of race/ethnicity.

LIMITATIONS

Generalizability to other minorities or to patients with poorer access to care may be limited.

CONCLUSIONS

The complex interplay among patient, physician and system characteristics contributed to disparities in HbA1c between Mexican American and non-Hispanic white patients. In contrast, Vietnamese American patients achieved HbA1c levels comparable to non-Hispanic whites and adjustment for numerous characteristics failed to identify confounders that could have masked disparities in this subgroup. Disease management mastery appeared to be an important contributor to glycemic control for all patient subgroups.

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Sherrie H. Kaplan
    • 1
  • John Billimek
    • 1
  • Dara H. Sorkin
    • 1
  • Quyen Ngo-Metzger
    • 1
  • Sheldon Greenfield
    • 1
  1. 1.Health Policy Research Institute and Department of Medicine, School of MedicineUniversity of California, IrvineIrvineUSA