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Harvard Vanguard Medical Associates
Eastern Massachusetts
African American


Providers receive cultural competency training and monthly race-stratified performance reports.

Over the course of 12 months, primary care physicians, nurse practitioners and physician assistants are given tools and training regarding racial disparities in health care. Participating clinicians attend lunchtime lectures that focus on racial disparities in the quality of diabetes care within the Harvard Vanguard health system as well as disparities by primary care teams. Sample race-stratified performance reports are presented for review and comment. Clinician feedback is utilized to revise the reports. Clinicians also attend a one-day (for physicians) or two-day (for nurse practitioners and physician assistants) cultural competency training, which includes lectures, discussions, introspective exercises and community tours.

Following the training, clinicians receive monthly race-stratified diabetes performance feedback reports, which include patient clinical data, information about patient experience and information about organization of care; and receive monthly informational sheets on delivering culturally tailored diabetes care.


The Chronic Care Model suggests that health care outcomes are linked to patient-provider interactions. Improving these interactions may lead to better health outcomes for minority patients. Positive working relationships are particularly important in diabetes care, where successful treatment is dependent upon establishment of a partnership between the patient and the clinical team.

Raising awareness among providers about racial and ethnic disparities in care is a first step, especially among those who are not aware that such disparities may exist in their own practices. Cultural competency training may lead to better clinician-patient relationships by helping clinicians better understand social and cultural factors that influence health behaviors affecting disease management and patient outcomes.

Performance feedback can stimulate local quality improvement activities. Giving providers feedback about racial disparities in their own practices may heighten awareness among individual clinicians, prompting efforts to improve health care for minority patients.

Summary Results

Offering cultural competence training, lunchtime lectures, and monthly race-stratified performance feedback reports successfully increased clinician awareness of disparities in their own patient panels (82% vs 59% controls). Clinicians in the intervention group were significantly less likely to report that cultural competency (17% vs 34% controls) and awareness of disparities (11% vs 33% controls) were effective strategies to reduce disparities. Though valuable, increasing clinician awareness alone was not sufficient to improve HbA1c, cholesterol, and blood pressure in patients with diabetes.


Cultural Competency Training and Performance Reports to Improve Diabetes Care for Black Patients: A Cluster Randomized, Controlled Trial
Annals of Internal Medicine. 2010; 152:40-46.Physician Performance and Racial Disparities in Diabetes Mellitus Care

Archives of Internal Medicine. 2008; 168(11):1145-115.
Full Article (subscription may be required)

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care
Journal of General Internal Medicine. 2008; 23(5): 678-684.Clinician’s Views on an Intervention to Reduce Racial Disparities in Diabetes Outcomes

Journal of the National Medical Association. 2011 Sep-Oct; 103(0): 968–977.
Full Article (subscription may be required)

Principal Investigator

  • Thomas D. Sequist, MD, MPH