Who, when, and how: the current state of race, ethnicity, and primary language data collection in hospitals (original) (raw)
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Health Services Research, 2009
Objective. To collect patient race/ethnicity and language (r/e/l) in an ambulatory care setting. Data Sources/Study Setting. The Palo Alto Medical Foundation (PAMF), December 2006-May 2008. Study Design. Three pilot studies: (1) Comparing mail versus telephone versus clinic visit questionnaire distribution; (2) comparing the front desk method (FDM) versus exam room method (ERM) in the clinic visit; and (3) determining resource allocation necessary for data entry. Data Collection/Extraction Methods. Studies were planned and executed by PAMF's Quality and Planning division. Principal Findings. Collecting r/e/l data during clinic visits elicited the highest response rate. The FDM yielded higher response rate than the ERM. One full-time equivalent is initially necessary for data entry. Conclusions. Conducting sequential studies can help guide r/e/l collection in a short time frame.
Collection of patient race, ethnicity, and language data in emergency departments: a national survey
Canadian Journal of Emergency Medicine
Purpose There is mounting evidence of racial and ethnic discrimination in the Canadian health care system. Patient level race and ethnicity data are required to identify potential disparities in clinical outcomes and access to health care. However, it is not known what patient race, ethnicity, and language data are collected by Canadian hospitals. This gap limits opportunities to identify and address inequalities in the health care system. The emergency department (ED) is a major point of contact for many patients accessing the health care system, and is therefore a reasonable place to conduct analysis of patient data collection. This study aims to quantify the proportion of Canadian EDs that collect patient race, ethnicity, and primary language data. Methods We identified all Canadian EDs and distributed a survey to 616 EDs across the country. Results We received responses representing 202 EDs (32.8%). One fifth (20.3%) of responding EDs reported that they collected race and ethnicity data and 38.1% collected primary language data. Reported uses for these data included quality improvement, research, and direct patient care. Conclusion The majority of Canadian EDs do not collect patient race, ethnicity, and language data. This gap limits our ability to identify inequalities in health outcomes or access to health care. Lack of race, ethnicity, and language data also hinders our ability to develop and evaluate programs and interventions that aim to correct these inequalities.
Perspectives in health information management, 2016
Well-designed electronic health records (EHRs) must integrate a variety of accurate information to support efforts to improve quality of care, particularly equity-in-care initiatives. This case study provides insight into the challenges those initiatives may face in collecting accurate race, ethnicity, and language (REAL) information in the EHR. We present the experience of an academic medical center strengthening its EHR for better collection of REAL data with funding from the EHR Incentive Programs for meaningful use of health information technology and the Texas Medicaid 1115 Waiver program. We also present a plan to address some of the challenges that arose during the course of the project. Our experience at an academic medical center can provide guidance about the likely challenges similar institutions may expect when they implement new initiatives to collect REAL data, particularly challenges regarding scope, personnel, and other resource needs.
Improving Hospital Reporting of Patient Race and Ethnicity-Approaches to Data Auditing
Health services research, 2015
To investigate new metrics to improve the reporting of patient race and ethnicity (R/E) by hospitals. California Patient Discharge Database (PDD) and birth registry, 2008-2009, Healthcare and Cost Utilization Project's State Inpatient Database, 2008-2011, cancer registry 2000-2008, and 2010 US Census Summary File 2. We examined agreement between hospital reported R/E versus self-report among mothers delivering babies and a cancer cohort in California. Metrics were created to measure root mean squared differences (RMSD) by hospital between reported R/E distribution and R/E estimates using R/E distribution within each patient's zip code of residence. RMSD comparisons were made to corresponding "gold standard" facility-level measures within the maternal cohort for California and six comparison states. Maternal birth hospitalization (linked to the state birth registry) and cancer cohort records linked to preceding and subsequent hospitalizations. Hospital discharges we...
Journal of General Internal Medicine, 2005
BACKGROUND: Experts recommend that health care providers (HCPs) collect patients’ race/ethnicity, but HCPs worry that this may alienate patients. OBJECTIVE: To determine patients’ attitudes toward HCPs collecting race/ethnicity data. DESIGN: Cross-sectional survey. PARTICIPANTS: General Internal Medicine patients (n = 220). MEASUREMENTS: Perceived importance of having HCPs collect race/ethnicity data, their concerns about this, comfort level providing this information, and reactions to 4 statements explaining the rationale for collecting this. RESULTS: Approximately 80% somewhat or strongly agreed that HCPs should collect information on patients’ race/ethnicity. However, 28% had significant discomfort (score 5 or less on 10-point scale) reporting their own race/ethnicity to a clerk, and 58% were somewhat or very concerned that this information could be used to discriminate against patients. Compared with whites, blacks, and Hispanics felt less strongly that HCPs should collect race/ethnicity data from patients (P=.04 for both pairwise comparisons), and blacks were less comfortable reporting their own race/ethnicity than whites (P=.03). Telling patients that this information would be used for monitoring quality of care improved comfort more than telling patients that the data collected (a) was mandated by others, (b) would be used to guide staff hiring and training, and (c) would be used to ensure the patient got the best care possible. CONCLUSIONS: Most patients think HCPs should collect information about race/ethnicity, but many feel uncomfortable giving this information, especially among minorities. Health care providers can increase patients’ comfort levels by telling them this will be used to monitor quality of care.
Harnessing Data to Assess Equity of Care by Race, Ethnicity and Language
International Journal of Environmental Research and Public Health, 2015
Objective: Determine any disparities in care based on race, ethnicity and language (REaL) by utilizing inpatient (IP) core measures at Texas Health Resources, a large, faith-based, non-profit health care delivery system located in a large, ethnically diverse metropolitan area in Texas. These measures, which were established by the U.S. Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC), help to ensure better accountability for patient outcomes throughout the U.S. health care system. Methods: Sample analysis to understand the architecture of race, ethnicity and language (REaL) variables within the Texas Health clinical database, followed by development of the logic, method and framework for isolating populations and evaluating disparities by race (non-Hispanic White, non-Hispanic Black, Native American/Native Hawaiian/Pacific Islander, Asian and Other); ethnicity (Hispanic and non-Hispanic); and preferred language (English and Spanish). The study is based on use of existing clinical data for four inpatient (IP) core measures: Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), Pneumonia (PN) and Surgical Care (SCIP), representing 100% of the sample population. These comprise a high number of cases presenting in our acute care facilities. Findings are based on a sample of clinical data (N = 19,873 cases) for the four inpatient (IP) core measures derived from 13 of Texas Health's wholly-owned facilities, formulating a set of baseline data. Results: Based on applied method, Texas Health facilities consistently scored high with no discernable race, ethnicity and language (REaL) disparities as evidenced by a low percentage difference to the reference point (non-Hispanic White) on IP core measures, including: AMI (0.3%-1.2%), CHF (0.7%-3.0%), PN (0.5%-3.7%), and SCIP (0-0.7%).
Enhancing Public Hospitals' Reporting of Data on Racial and Ethnic Disparities in Care
To assess the ability of hospitals with large minority populations to use existing quality-of-care measures to reduce racial/ethnic disparities, the researchers analyzed quality-related data on acute myocardial infarction, heart failure, and pneumonia by patients' race and ethnicity from five major public hospitals. Senior clinical and administrative leaders were interviewed about their use of quality data and views on disparities and public data reporting. These hospitals exceeded national norms on most measures, and high performance was mostly consistent across racial and ethnic groups. While the findings should be interpreted cautiously, the data indicated some disparities in performance measures related to patient communication. The study also revealed limitations in use of commonly accepted quality measures for detecting disparities. None of the study hospitals had previously looked at these measures by race or ethnicity, and hospital leaders were not in agreement as to wh...
The Legality of Collecting and Disclosing Patient Race and Ethnicity Data
2006
This Policy Brief, prepared for the Robert Wood Johnson Foundation, analyzes the following question: Whether the collection of patient data by race or ethnicity, as part of a program of quality improvement, violates the law. 74 Id. at Section 2, adopting new Public Health Service Act § 921(4). 75 Id. at § 921(7)(A). 76 Id. at § 921(5). 77 Id. at § 922(a). 78 Id. at § 922(d).