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IIR 14-007 – HSR&D Study

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IIR 14-007
Opening the Black Box of Cultural Competence
Somnath Saha MD MPH
VA Portland Health Care System, Portland, OR
Portland, OR
Funding Period: September 2016 - September 2021

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.


Journal Articles

  1. Myaskovsky L, Kendall K, Li X, Chang CH, Pleis JR, Croswell E, Ford CG, Switzer GE, Langone A, Mittal-Henkle A, Saha S, Thomas CP, Adams Flohr J, Ramkumar M, Dew MA. Unexpected Race and Ethnicity Differences in the US National Veterans Affairs Kidney Transplant Program. Transplantation. 2019 Dec 1; 103(12):2701-2714.
  2. Chan B, Goldman LE, Sarkar U, Guzman D, Critchfield J, Saha S, Kushel M. High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population. BMC health services research. 2019 May 24; 19(1):334.
  3. P Goddu A, O'Conor KJ, Lanzkron S, Saheed MO, Saha S, Peek ME, Haywood C, Beach MC. Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. Journal of general internal medicine. 2018 May 1; 33(5):685-691.
  4. Gollust SE, Cunningham BA, Bokhour BG, Gordon HS, Pope C, Saha SS, Jones DM, Do T, Burgess DJ. What Causes Racial Health Care Disparities? A Mixed-Methods Study Reveals Variability in How Health Care Providers Perceive Causal Attributions. Inquiry : A Journal of Medical Care Organization, Provision and Financing. 2018 Jan 1; 55:46958018762840.
  5. Burgess DJ, Bokhour BG, Cunningham BA, Do T, Gordon HS, Jones DM, Pope C, Saha S, Gollust SE. Healthcare Providers' Responses to Narrative Communication About Racial Healthcare Disparities. Health communication. 2019 Feb 1; 34(2):149-161.
  6. Beach MC, Branyon E, Saha S. Diverse patient perspectives on respect in healthcare: A qualitative study. Patient education and counseling. 2017 Nov 1; 100(11):2076-2080.
  7. Cuevas AG, O'Brien K, Saha S. What is the key to culturally competent care: Reducing bias or cultural tailoring? Psychology & Health. 2017 Apr 1; 32(4):493-507.
  8. Callon W, Beach MC, Saha S, Chander G, Wilson IB, Laws MB, Sharp V, Cohn J, Moore R, Korthuis PT. Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures? Journal of general internal medicine. 2016 Oct 1; 31(10):1141-7.
  9. Burgess DJ, Beach MC, Saha S. Mindfulness practice: A promising approach to reducing the effects of clinician implicit bias on patients. Patient education and counseling. 2017 Feb 1; 100(2):372-376.

DRA: Health Systems, Diabetes and Related Disorders
DRE: Treatment - Observational
Keywords: Best Practices, Cultural Competence, Diabetes, Disparities, Outcomes - Patient, Patient-Provider Interaction
MeSH Terms: none

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