Eliminating Health Disparities Measurement and Data Needs (2004) / Chapter Skim
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Appendix F Collection of Data on Race and Ethnicity by Private-Sector Organizations: Hospitals, Health Plans, and Medical Groups
Appendix F Collection of Data on Race and Ethnicity by Private-Sector Organizations: Hospitals, Health Plans, and Medical Groups
Pages 249-271
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From page 249... ...
. There is evidence, for example, of racial and ethnic disparities in the stage of breast cancer at diagnosis (presumed to at least partially reflect screening *
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From page 250... ...
, then it is important to understand how hospitals, health plans, and medical groups can play a role in reducing disparities. In the domains of quality measurement and quality improvement, these organizations already play important roles, as indicated below.
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From page 251... ...
· Responsible for implementing clinical guidelines and designing disease management programs · Able to use a variety of financial and other incentive systems to alter clinician behavior Medical Groups: · Able to enforce clinical guidelines and policies · Able to select group members on the basis of compatible practice styles · Able to maintain medical records systems, registries, and other sorts of data systems used to measure quality of care · Able to design and implement compensation systems that reward quality From the perspective of the purchaser, responsibility for assessing and improving quality of care has largely been delegated to health plans and hospitals. For health plans, requirements for National Committee for Quality Assurance accreditation and comparison using HEDIS measures and CAHPS results represent methods by which purchasers attempt to improve quality of care.
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From page 252... ...
The availability of data on race, ethnicity, and primary language is crucial to these organizations' ability to focus their efforts on quality improvement and reduction or elimination of disparities. Initiatives that seek to expand translation services, community outreach programs, access to care, and quality improvement will be much more beneficial to members of racial, ethnic, or linguistic minority groups if they are guided by information on the groups most affected by disparities and the extent to which specific structural or process variables are responsible for those disparities.
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From page 253... ...
The passage of the Civil Rights Act and subsequent enforcement actions by the OEHO (or credible threats of such actions) served to eliminate the most overt forms of segregation and discrimination in relatively few years, primarily because the subsequent passage of Medicare and Medicaid legislation gave federal officials a powerful financial tool to use to force compliance with Title VI requirements.
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From page 254... ...
According to an official at the Michigan Health and Hospital Association, the Michigan Inpatient Database (a collection of discharge abstracts from essentially all general medical/surgical hospitals in the state) includes racial and ethnic data for approximately 75 percent of patient records (Robert Zorn, 2002, personal communication, Sparrow Regional Health System)
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From page 255... ...
, which carries only four racial codes: white, black, other, and unknown. The Medicare EDB is updated using information from another SSA file called the NUMIDENT file that carries seven codes: white, black, other, unknown, Asian, Hispanic, Northern American Indian or Alaska Native.
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From page 256... ...
Although we are reluctant to draw conclusions from such a relatively small sample, it appears that health plans are less likely than hospitals to collect data on enrollees' race and ethnicity. Those that do, use the information primarily to translate materials, for quality improvement purposes, and to inform disease management programs.
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From page 257... ...
. An informal survey of health plan representatives invited to attend the 1999 DHHS meeting, and a concurrent telephone and e-mail survey of large not-for-profit health plans involved in the HMO Research Network, indicated that essentially no plans routinely collected data on the race or ethnicity of their members at that time.
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From page 258... ...
We presume that the main reason for this difference is the legal requirements imposed on hospitals by the 1964 Civil Rights Act, even if the enforcement of those requirements is not very stringent today and even if the original requirements did not specifically include collection of data on the race or ethnicity of individual patients. State-level requirements for collection and reporting of data seem to be an important driving force for those hospitals that do collect racial and ethnic data.
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From page 259... ...
versus on some other basis such as visual observation on the part of a registration clerk; · the extent to which information on race and ethnicity is complete and accurate as assessed by agreement with other data sources; and · the extent to which information on race and ethnicity is used in the context of quality improvement and/or disparity reduction initiatives. These issues of "process" for the collection of data on race and ethnicity (and other demographic factors such as SES)
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From page 260... ...
In the near term, though, several general strategies for reducing concern can be identified: · Involve community leaders in all aspects of the planning and design of processes for data collection, data analysis, and use of data for quality improvement. · Take all possible opportunities to communicate with community groups about the reasons for collection of data and the use of data for quality improvement purposes.
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From page 261... ...
Data collected for special purposes, though (e.g., CAHPS data for health plans; disease registries for medical groups) can be used effectively for initiatives aimed at reducing disparities.
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From page 262... ...
In quiry 38:319-330. Institute of Medicine 2003 Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
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From page 263... ...
SUMMARY OF SURVEY OF AMERICAN HOSPITAL ASSOCIATION HOSPITALS In 2003, the Institute of Medicine released the report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which highlighted the importance of collecting patient data by race, ethnicity, and primary language. The report noted that if such data were collected, researchers, policy makers, and clinicians could disentangle factors associated with health care disparities, facilitate monitoring of performance, ensure accountability to health plan members and health care purchasers, improve patient choice, and identify discriminatory practices.
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From page 264... ...
reported that they collect racial and ethnic data about patients. Fifty-seven percent of those respondents indicated that more than one unit or clinic within the hospital collected data.
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From page 265... ...
Seventeen percent indicated other reasons for collecting these data such as: it is required by the state; it is included as basic demographic information for medical records or a hospital database or cancer registry; it is required by the state hospital association; and it is used for teaching and for conducting research on best practices, trends, and preventive care. Eighty-six percent of respondents indicated that they provide specific categories for patients or guardians to check off when data on race and ethnicity are collected, and 14 percent of the respondents reported collecting the information using a "fill in the blank" open question.
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From page 266... ...
Specific racial and ethnic categories and the percentage of hospitals that used them are listed below. Caucasian/White 95% African American/Black 94% Spanish/Hispanic/Latino 81% American Indian 77% Asian 77% Alaska Native 26% Other Pacific Islander 24% Mexican, Mexican American, Chicano 11% Native Hawaiian 9% Asian Indian 8% Chinese 8% Filipino 7% Japanese 7% Puerto Rican 5% Cuban 4% Vietnamese 4% Samoan 4% Korean 4% Guamanian or Chamorro 1% Hospitals were asked in what percentage of cases data on race and ethnicity were missing or unavailable.
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From page 267... ...
Seventy-two percent of the respondents that collect racial or ethnic data did not see any drawbacks to collecting such data. Drawbacks that were reported most often included discomfort on the part of the registrar or admitting clerk asking the patient for the information; problems associated with the accuracy of the data collected; a sense that patients might be insulted or offended, or resist answering questions about their race and ethnicity; patients often don't "fit" the categories that are given; and a fear that data may not be kept confidential.
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From page 268... ...
Only one of the 54 hospitals not currently collecting racial or ethnic data indicated it was engaged in efforts to change its policies related to the collection of these data for the purposes of determining patients' primary language. Respondents from hospitals that were not changing their existing policies stated there was no need to collect data on race and ethnicity because it was unnecessary, it was not a priority or a concern, the patient population was over 95 percent Caucasian, and one stated it was "against the law." Hospitals that did not collect data on race or ethnicity were also asked whether they saw any drawbacks to collecting these data; of these hospitals, 44 percent answered "no" and 56 percent answered "yes." Respondents stated that the time and resources involved in collecting and managing the data would be a barrier to its collection.
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From page 269... ...
The final sample of health plans responding to the survey represented approximately 16.3 million enrollees from the various health plan products and provided information about 69 commercial, Medicaid, and Medicare health plan products. Findings Of the 38 health plans that responded to the survey, 13, or 34 percent voluntarily collected data on the race and ethnicity of their health plan members and 23, or 61 percent did not at this time.
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From page 270... ...
. Among the responses received from health plans that did not voluntarily collect data, eight stated that data collection was unnecessary, seven stated that it was legally allowed but not authorized by the health plan, six stated that either they had concerns about the enrollee's reactions, or there was no good or reliable system for collection, two stated that either it was prohibited by law or external regulation or they did not know, and one response indicated that either the data would be unreliable, too costly to collect and maintain, or there was no good or reliable classification system for race and ethnicity.
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From page 271... ...
Those groups that do collect data do so primarily for internal quality improvement or disease management purposes rather than because of an external reporting requirement. Groups that do not collect data feel that it is either unnecessary or potentially troubling to patients, or that it cannot be done reliably.
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