collection of race, ethnicity, and language data at henry ...hfhs work group – summer, 2010 pilot...

Collection of Race, Ethnicity, and Language Data

at Henry Ford Health System

David R. Nerenz, Ph.D. Director, Center for Health Policy and

Health Services Research

These slides are the property of the presenter. Do not duplicate without express written consent.

National Initiatives

Healthy People 2010 provided a roadmap for improving the health of all people in communities across the nation. The two HP goals are:

1) Increase the quality and year of healthy life 2) Eliminate health disparities National Healthcare Disparities Report National Healthcare Quality Report “Meaningful Use” requirements for EHR systems


Why Should HFHS Collect Patient Race/Ethnicity, and Primary Language

Data

1. Deliver and monitor quality of care rendered 2. Know our patients to meet unique needs and

show communities that we deliver the best care possible

3. Design innovative programs to eliminate disparities and rigorously test them

4. Satisfy legal, regulatory and accreditation requirements (i.e.: JCAHO, CMS, etc.)

5. Take a leadership position and model best an evolving best practice


To Improve Quality of Care We Need To Collect Data

Quality of care can be hindered because of limited or incomplete communication, language differences, or cultural barriers

The delivery of quality care could be enhanced if mechanism to collect accurate data exist to address these challenges

Unable to accurately assess health outcomes for different groups


REL Data Collection at HFHS

Prior to Current Initiative

All analyses were based on racial/ethnic data available in Corporate Data Store

Inconsistent process for soliciting race/ethnic information

Categories were limited

Classification often based on registration clerk perception, resulting in some misclassification

Unable to select multiple racial or ethnic categories


Exercise in identification of race and ethnicity at HFHS

Original Data Downloaded by Electronic Medical Records

Chart review/patient report

n % n % % difference

Hispanic 23 1.5 78 5.0% +3.5%

Afr. American/Black 667 42.6 708 45.3% + 2.7%

White 722 46.2 684 43.7% - 2.5%

Arab American 13 0.8 61 3.9% + 3.1%

Asian 10 0.6 30 1.9% +1.3%

Unknown 129 8.2 3 0.2% - 8.0%

*n=1564 These slides are the property of the presenter. Do not duplicate without express written consent.

Presenter

Presentation Notes

Using this same data, We were able to take a look at the distribution of race and ethnicity in our patient population using the OMB recommended classifications. Just using databases, we had minimal misclassification of our two largest race groups about 8.0% unknown Actually see a larger percentage of classification of hispanic, asian, arab american, using self-report as would be expected.

Advising the Nation.

Improving Health.

Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement September 15, 2009


Subcommittee Charge

• Report on the issue of standardization of race, ethnicity, and language variables

• Define a standard set of race, ethnicity, and language categories, and methods of obtaining these data


“Disparities in the health care delivered to racial and ethnic minorities are real and are associated with worse outcomes in many cases, which is unacceptable.” - Alan Nelson, retired physician, former president of the American Medical Association

IOM Report, 2003: “Unequal Treatment”


Presenter

Presentation Notes

The future health of America as a whole will be influenced substantially by our success in improving the health of ethnic and racial minorities groups. People of color (Latinos, African Americans, Asian/Pacific Islanders, and American Indian/Alaska Natives) make up nearly a third of the U.S. population. By the year 2050, the U.S. Census estimates that these groups combined will make up nearly half of the U.S. population. Groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population.

Recommended variables for standardized collection of race, ethnicity, and language need

OMB Race (Select one or more)

• Black or African

American • White • Asian • American Indian or

Alaska Native • Native Hawaiian or Other

Pacific Islander • Some other race

Granular Ethnicity • Locally relevant choices

from a national standard list of approximately 540 categories with CDC/HL7 codes

• “Other, please specify:___” response option

• Rollup to the OMB categories

Spoken English Language Proficiency

• Very well • Well • Not well • Not at all (Limited English proficiency is defined as “less than very well”)

Spoken Language Preferred for Health Care

• Locally relevant choices from a

national standard list of approximately 600 categories with coding to be determined

• “Other, please specify:__” response option

• Inclusion of sign language in spoken language needs list and Braille when written language is elicited

OMB Hispanic Ethnicity • Hispanic or Latino • Not Hispanic or Latino

Rac

e an

d Et

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Lang

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Recommendation: Granular Ethnicity • Collect granular ethnicity data as a

separate variable from the OMB race and Hispanic ethnicity categories

• Granular ethnicity categories should be selected from a national standard list

• Lists should include an “Other, please specify:__” option for additional self-identification


Presenter

Presentation Notes

Granular ethnicity is defined as one’s ancestry—“a person’s ethnic origin or descent, ‘roots,’ or heritage, or the place of birth of the person or the person’s parents or ancestors Granular ethnicity is collected in a separate question from race and Hispanic ethnicity; the concepts are separate. The granular ethnicity categories an entity includes on its data collection forms or in its data collection systems should be selected from a national standard set. Categories should be selected on the basis of health and health care quality issues, evidence or likelihood of disparities, or size of subgroups within the population.

Selecting Locally Relevant Granular Ethnicity Categories

Local circumstances can dictate whether an entity uses 10 or 100 categories from the national standard list; criteria for selection:

• Health and health care quality issues • Evidence or likelihood of disparities • Size of subgroups within the population • Analyses of relevant data on the service or

study population


Presenter

Presentation Notes

The subcommittee expects the number of categories and the detail of lists to vary across contexts and localities.


Presenter

Presentation Notes

The CDC/HL7 code set is hierarchical; each ethnicity category rolls up to an OMB race or Hispanic ethnicity. But not all ethnicities have corresponding races. With some degree of certainty, Nigerians can be categorized as Black. But not everyone from Madagascar is Asian. So rolling up as Madagascans to Asian misclassifies Africans of Madagascan descent.

Rationale for Language Need Data

Persons with limited English proficiency are at risk for:

• Decreased access to care and having a usual source of care

• Adverse outcomes from medical errors and drug complications

• Less utilization of preventive care services


Time Line for REL Initiative

IOM Report on Standardization of REL data collection – September, 2009 Patient focus groups – March, 2010 HFHS work group – Summer, 2010 Pilot testing and staff training – Spring, 2011 Roll-out in some clinics – Summer, 2011 Full roll-out – December, 2011


General Approach

Two methods – Call Center staff or Registration Clerk

Phone or in-person questions

– Form for patient or family member to fill out

For new patients, at time of registration For established patients, at time of clinic visit or other

encounter Multiple fields in registration module feed other data

systems (e.g., medical records)


Registration and Waiting Room Signage


These next questions are about your race, ethnicity, and primary language. Hospitals are being required to ask these questions to meet certain regulatory standards. We are committed to ensuring all patients receive the best possible care. Completion of this form is voluntary. 1. Are you of Hispanic or Latino origin?

Yes No Decline Do not know 2. Are you of Arab or Chaldean origin?

Yes No Decline Do not know

3. Which of the following best describes your race? If necessary, you may select up to two.

Asian Black American Indian/Alaska Native Native Hawaiian/Pacific Islander White Decline Do not know Other___________________________________

4. Please provide one or two nationalities or ethnic groups that best describe your ancestry. (For example, Italian, Jamaican, African American, Haitian, Korean, Lebanese, etc.) Groups noted below are among the most frequently selected according to our current data. This list will be updated periodically. If your nationality/ethnicity is not listed, please mark "Other" and write in your preference.

African American Greek Palestinian Albanian Hungarian Polish Armenian Indian (East Asian) Puerto Rican Belgian Iraqi Romanian Bangladeshi Iranian Russian Chaldean Irish Scottish Chinese Italian Spanish (Spain) Chippewa/Ojibwe Jamaican Swedish Cuban Japanese Syrian Czech/Slovakian Jewish Yemeni Dutch Jordanian Vietnamese Egyptian Korean Ukrainian English Lebanese Filipino Macedonian Other (specify)_______________ Finnish Maltese _____________________________ French Mexican German Nigerian Do not know

5. How would you rate your ability to speak English?

Very well Not well Decline Well Not at all Do not know

6. What language do you feel most comfortable using when discussing your health care?

Sign Language (American) Cantonese Russian Decline Albanian English Spanish Do not know Arabic Italian Vietnamese Other (specify_________________) Bengali Mandarin Yemen Arabic

Thank you. Please return this form to a front desk staff member.

Henry Ford Health System Patient Demographic Form

Patient name___________________________ MRN_________________________________ Date__________________________________


Current Status

Some challenges in initial roll-out period – Competing tasks for clinic staff – Patient questions or concerns

Process going relatively smoothly now Approximately 15-25,000 new “forms”

completed each month. Part of regular registration process, not a

“special project”


Conclusions

Data on REL a necessary condition for quality improvement and disparity reduction Recommendations of 2009 IOM committee can

be implemented in regular clinic operations Useful to allow for multiple methods of data

collection Good levels of staff and patient acceptance

after initial adjustment period


collection of race, ethnicity, and language data at henry ...hfhs work group – summer, 2010 pilot...

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