In this collaborative study with the Eidos LGBTQ+ Initiative at UPenn, we measured whether clinicians with Violet Benchmarks had better patient outcomes than clinicians who did not earn a Benchmark.
Violet Benchmarks were created as a way to measure cultural competence at the provider level. Unlike using self-attestation and lived experience as a proxy for cultural competence, Violet Benchmarks are a standardized, integrated system that assesses culturally competent care across communities.
In a recent study, Violet partnered with a behavioral health organization to determine whether the Violet benchmarks served as a clinical care quality measure, investigating whether clinicians with Benchmarks had better patient operational and clinical outcomes than clinicians who did not earn a Violet Benchmark. The clinicians were all therapists with a variety of graduate degrees and licensure (PhD, LCSW, LMHC, etc.) and the care used for analysis was with culturally diverse clients (BIPOC, LGBQ, and/or TGNC). The Eidos LGBTQ+ Health Initiative at the University of Pennsylvania provided the Violet research team with data technical assistance reviewing and assessing the study findings.
An overview of study structure.
The findings covered outcomes across the full patient care journey, from first match with a clinician to treatment completion. Key outcomes included: matching with a clinician on the first attempt, first appointment adherence, overall session adherence, one month treatment completion, overall patient retention, therapeutic alliance, and decreases in PHQ-9 and GAD-7 scores for symptoms of depression and anxiety.
The study split the clinicians into two groups:
- Clinicians who earned Violet Benchmarks at the “Awareness” level or above.
- Clinicians who did not earn a Violet Benchmark for any community.
To compare these groups, a series of tests assessed differences in continuous outcomes, like overall session adherence and therapeutic alliance scores and differences in likelihood of categorical outcomes, like treatment retention and matching with a clinician on first attempt.
Key findings.
The patient care journey findings showed:
Clinicians with Violet Benchmarks had better patient matching.
- 18% higher rate of first-attempt match (78% vs 60%)*
- 2.42x more likely to match*
Clinicians with Violet Benchmarks had higher patient adherence.
- 12% higher first appointment adherence (83% vs 71%)*
- 13% higher overall session adherence (66% vs 53%)*
Clinicians with Violet Benchmarks had higher patient retention.
- 15% higher one month treatment completion (59% vs 44%)*
- 11% higher overall retention rate (83% vs 72%)
Patients of clinicians with Violet Benchmarks had better clinical outcomes.
- Higher therapeutic alliance*
- Greater PHQ-9 score decrease (-2.65 vs -0.50)*
- Greater GAD-7 score decrease (-2.27 vs -1.50)
*statistical significance, p < 0.05
Our research is the first to show that cultural competence positively impacts care outcomes throughout the full patient journey, from match to clinical outcomes. When patients see a clinician who has extensive education, work experience, and a desire to treat their community, patients will not only have a better experience, they will get better care. We found that these patients have an easier time matching with a provider, attend more appointments, and get better faster.
With the current push for tangible health equity interventions, training clinicians in inclusive care practices and routing patients to clinicians who excel treating their communities will become crucial in working to end health disparities. Clinicians need a baseline measure to understand where they can continue to upskill, while patients need to be able to find providers who specialize in caring for their identities. This study provides initial validation that Violet Benchmarks are able to serve as that measure and capture clinician quality, and further point to the necessity of provider inclusivity data in our health care system.
Read the full whitepaper here.
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