Ensuring that care is delivered equitably across different veteran populations has been a longstanding VA priority. Cultural competence (CC) training has burgeoned in the last decade throughout the U.S., as a measure to reduce disparities in care delivery, and has been promoted by the VA. However, most CC programs are delivered without a sound evidence base to inform their content. In our prior study - "Measuring Cross-Cultural Competence in VA Primary Care" (VA HSR&D ECV 04-296) - we found that primary care providers (PCPs) with higher levels of CC, measured using self-administered scales that we previously developed, receive higher ratings of care from minority patients with diabetes, such that there were fewer racial disparities in the quality of care delivered by high CC providers.
The goals of this project are to: 1) understand differences in patient-provider communication among high and low CC PCPs; 2) understand patients' perceptions of their interactions and relationships with high and low CC PCPs and other patient-aligned care team (PACT) members; and 3) understand the contribution of CC among PCPs/PACTs to quality and equity of diabetes care.
We will conduct a mixed-methods at 4 geographically diverse VA medical centers, recruiting approximately 50 PCPs and PACTs, and a target sample of 5 African American and 5 white patients with diabetes per PACT. We will evaluate self-assessed CC among recruited PCPs and PACT members. We will audio-record visits between each recruited patient and his/her PCP and will quantitatively and qualitatively analyze communication patterns in these visits to understand differences in patient-provider communication among high and low CC PCPs. We will conduct brief surveys with each patient and will interview a subsample of them, to understand patients' perceptions of their interactions and relationships with high and low CC PCPs and PACT members. Finally, we will examine the association of PCP/PACT CC with self-reported and clinical outcomes, to understand the contribution of CC to quality and equity of diabetes care.
No findings to date. Data collection is in process at all sites.
The purpose of this project is to provide evidence to inform effective CC training, both within and outside VA. Evidence-based CC training is a priority for the VA, as evidenced by the establishment of the Division of Cultural Competence and Communication, within the VHA's Office of Health Equity (OHE). Our findings will inform national VA efforts to reduce racial and ethnic disparities in care delivery.
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Diabetes and Related Disorders, Health Systems
Treatment - Observational
Best Practices, Cultural Competence, Diabetes, Disparities, Outcomes - Patient, Patient-Provider Interaction