Standardizing Patient Race, Ethnicity

and Language Data Collection:Overview

October 1, 2010Memphis, TN

Aligning Forces for Quality National Program Office

2

Why are we here?

• Understand key decision points in implementing standardized race, ethnicity and language (R/E/L) data collection within your organization

• To provide you with the knowledge and tools to train staff on the standardized collection of R/E/L data

3

What are disparities in health care quality?

• “Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities”

• Less likely to receive:– Cancer screening– Cardiovascular therapy– Kidney dialysis– Transplants – Curative surgery for lung cancer– Hip and knee replacement  – Pain medicines in the ER

4

National CABG rates

0.0

2.0

4.0

6.0

8.0

10.0

12.0

1 2 3 4 5 6 7 8 9 10 11 12 13

year 1993 - 2005

Whitemen

Blackmen

Jha, NEJM, 2005

Rate

per

1,0

00

Med

icare

en

roll

ees

5

Growing U.S. minority population

0

50

100

150

200

250

300

2010 2015 2020 2025 2030 2035 2040 2045 2050

Po

pu

lati

on

in

mil

lio

ns

Non-Hispanic White

Other

Population Projections, 2010 to 2050

Source: U.S. Census Bureau, 2009 National Population Projections (Supplemental) 4. Projections of the Population by Sex, Race, and Hispanic Origin for the United States: 2010 to 2050

6

Increasing legislative and regulatory attention to R/E/L

data• American Recovery and Reinvestment Act of 2009

– Hospitals and providers will need to collect R/E/L data to be eligible for “meaningful use” incentive payments

– Race/Ethnicity categories to follow Office of Management and Budget guidelines

• Patient Protection and Affordable Care Act of 2010 – Health programs receiving federal money are required to

collect R/E/L data

• Revised Joint Commission standards– Expand requirements related to the collection of patient

language data, including preferred spoken language and written communication needs

– New requirement to collect patient-level demographic data on race and ethnicity

7

OMB guidelines: Race, ethnicity and language

categoriesRace• Black• White• Asian• American

Indian/Alaska Native

• Native Hawaiian/ Pacific Islander

• Multiracial*• Declined*• Unavailable*

Language• English• Spanish• Other• Declined • Unavailable

*This designation indicates a modification to the OMB R/E categories

Ethnicity• Hispanic• Not Hispanic• Declined*• Unavailable*

8

Three steps in addressing disparities

• Standardized collection of self-reported R/E/L data– Categories are standardized

– Patient self-reports

• Stratification and analysis of performance measures

• Use of stratified data to identify and develop quality improvement interventions targeted to specific patient populations

Disparities in care represent a failure in quality

9

What is the current status of R/E/L data collection?

• Most hospitals collect data but not in a standardized manner– Few hospitals use data collected to

drive quality improvement

• Few ambulatory providers collect or use data– More common in health centers and

integrated health systems than in smaller physician practices

10

What change needs to happen?

• Develop the capacity and infrastructure to collect standardized race, ethnicity and language information from all patients

• This will affect: – Registration system and processes– Staff training and workflow– Patient communications– How data are used to monitor quality

11

What will we cover today?

• Building blocks toward equitable care– National health care disparities – Linking R/E/L data to quality– Increasing attention R/E/L data

• Key Decision Points– Changes at the organizational level

• Nuts and Bolts– Tools to train your staff

• Available resources