The goal of this study was to describe overall adherence to prevention and management guidelines in a large, urban HMO, and to test the hypothesis that adherence differs by patient race. Data were derived from chart reviews of patients aged 45 years or older who were members of the Kaiser Permanente Medical Care Program of Northern California, met specific study criteria for NIDDM, and were treated for signs or symptoms of diabetes between January and June 1992.

Blacks had higher age-adjusted levels of complication risk factors (measured by mean HbA1c, HDL cholesterol, diastolic blood pressure, and hypertension) than whites, and, for some factors, higher than Hispanics. However, the distribution of the total number of eight generally accepted prevention measures was nearly identical across the four racial/ethnic groups. (Measures include four lab tests, and ophthalmology referral, foot exam referral, blood pressure check, and health education referral/discussion.) Of 8 possible points (one for each of the prevention measures that applied to a patient), the adjusted difference between blacks and whites was 0.59; the study sample average score was about 5. Adjusting for age, gender and duration of diabetes, blacks had a significantly higher prevention score than whites. Prevention scores did not vary by physician characteristics.

It should be noted that adherence to the 4 lab tests was generally less than 50% across racial groups. Thus, while racial bias doesn’t appear to be operating, physician practices should be better monitored with regard to care of diabetic populations.

The authors conclude that in this HMO setting—in which most financial barriers to care are eliminated--few significant differences were noted by patient race/ethnicity in prevention practices. We must also consider that this patient population was 61% black, which might have positively affected the quality of health care services offered to blacks because they were a majority of the patient-mix.