Table 4 Multi-level disparities tailoring in Project ReD CHiP’s interventions
| Â | Â | Blood pressure measurement | Care management | Provider education |
|---|---|---|---|---|
|  | Disparities Specific Rationale | • Clinical uncertainty is believed to be a major contributor to healthcare disparities [23] | • Racial disparities in blood pressure control are due, in part, to poorer adherence to medications [24], limited access to healthful foods [25] and poor quality diets [26] | • PCPs use less patient-centered communication in visits with African American patients [27, 28]; patients with low health literacy ask their physicians fewer questions about medical care issues [29] |
|  |  | • Standardization of healthcare processes may reduce clinical uncertainty and variations in care [30] | • 2Motivational interviewing is effective at promoting health behavior change [31, 32], medication adherence [33] and health outcomes [31–33] in African Americans | • The combination of cultural competency training and race-stratified performance reports increases clinician awareness of racial disparities in care [34] |
|  |  |  | • Delivery of culturally and linguistically-tailored health information increases acceptability of interventions in minority populations [35] | • PCP communication skills training improves patient-reported outcomes and blood pressure control in ethnic minorities and poor persons [36] |
Disparities Tailoring | Patient | • Poster messages and images reduce patient anxiety and promote trust | • Educational materials culturally and linguistically tailored | • Patient scenarios include individual and environmental determinants of disparities and demonstrate methods to address them |
|  |  | • Motivational interviewing enhances patient engagement and addresses individual determinants of disparities |  | |
|  |  | • Community resource guide addresses environmental determinants of disparities |  | |
Provider and Staff | • Re-training videos use local staff as role models | • Care managers enhance providers’ ability to address patients’ complex psychosocial needs by providing additional counseling and support | • Dashboard increases provider awareness of disparities | |
|  |  |  | • Communication skills training enhances provider participatory skills leading to increased patient trust and engagement | |
Clinic | • Patient posters provide culturally and linguistically tailored communication | • Availability of phone contacts and flexible appointment times enhances access | • Financial incentives reward providers for reviewing disparities data | |
|  |  |  | • Financial incentives encourage providers to make referrals |  |