The Lupus Initiative will assist providers in acquiring: (1) more knowledge about diagnosis and treatment of lupus, (2) awareness of and strategies for managing what may be their implicit biases and (3) more effective and inclusive patient communication skills.

1. Education about lupus diagnosis and treatment best practices.
   Patients experience better outcomes when cared for by providers with more knowledge and experience in caring for lupus. And there is a correlation between quality of care and the specialty of a patient’s main physician. Our resources will fill educational gaps and provide information on making appropriate referrals to specialists, particularly rheumatologists.
2. Education about counter-balancing implicit bias.
   Studies have shown that physicians have no fewer implicit biases than the general United States population.¹ The good news is that studies have also shown that implicit biases are highly malleable. Strategies for managing implicit biases include:
   1. improving decision-makers’ self-awareness of their biases,
   2. exposing decision-makers to individuals who disconfirm the stereotype², and
   3. having decision-makers reconsider their decision making processes. Through resources including self-assessments, graphic depictions, data vignettes and possibly implicit association tests, The Initiative will help provider decision-makers s become more self-aware of their biases that relate to disparities.
3. Education about effective and inclusive communication approaches.
   Because ”[c]ultural competency is one the main ingredients in closing the disparities gap in health care,” ³ The Lupus Initiative will supply resources about the latest science in communications and communicating across cultures. Skilled communication is a key to providing effective behavior change counseling to patients about eating habits, smoking, exercise and adherence.⁴

¹See e.g., Green A, Carney D, Pallin D et al. Implicit Bias Among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients. Journal of General Internal Medicine. 2007:22(9):1231-1238 (suggesting that physicians’ unconscious biases may contribute to racial/ethnic disparities in use of medical procedures).

²See e.g.,. Saha S, Guiton G, Wimmers P, Wilkerson L. Student Body Racial and Ethnic Composition and Diversity-Related Outcomes in US Medical Schools. The Journal of the American Medical Association 2008;300(10):1135-45 (student body diversity within medical schools consistent with the goal of preparing students to meet the needs of a diverse population).

³HHS. What is Cultural Competency? http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11. Updated October 19, 2005. Accessed May 16, 2011. See also, Price E, Beach M, Gary T, et al. A systematic review of the methodological rigor of studies evaluating cultural competence training of health professionals. Academic Medicine: Journal of the Association of American Medical Colleges. 2005;80(6):578-86; Beach M, Price E, Gary T, et al. Cultural competence: a systematic review of health care provider educational interventions. Medical Care. 2005;43:356-73; Beach M, Gary T, Price E, et al. Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions. BMC Public Health. 2005;6:104. doi:10.1186/1471-2458-6-104 (indicating that cross-cultural care training can improve a professional’s knowledge, attitude, and skill).

⁴See, Bell K., Cole B., (2008) Improving Medical Students' Success in Promoting Health Behavior Change A Curriculum Evaluation Journal of General Internal Medicine 23(9): 1503-1506.