Race, Ethnicity, and Language Data Standardization for Health Care Quality Improvement (2009) / Chapter Skim
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, formed the Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement to identify current models for collecting and coding race, ethnicity, and language data; to ascertain the challenges involved in obtaining these data in health care settings; and to make recommendations for improvement. The language in the statement of task (Box S-1)
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. CATEGORIZING RACE AND ETHNICITY DATA The OMB race and Hispanic ethnicity categories represent broad population groups used for an array of sta tistical reporting and analytic purposes, including health care quality assessment and identification of disparities (AHRQ, 2008a; Cohen, 2008; Flores and Tomany-Korman, 2008; IOM, 2008; Kaiser Family Foundation, 2009)
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, as well as whether responses are self-reported or observer-reported. Fig S-1 and 6-1 a The preferred order of questioning is Hispanic ethnicity first, followed by race, as OMB recommends, and then granular ethnicity.
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When respondents do not self-identify as one of the OMB race categories or do not respond to the Hispanic ethnicity question, a national scheme should be used to roll up the granular ethnicity categories to the applicable broad OMB race and Hispanic ethnicity categories to the extent feasible. Eliciting accurate and reliable race, Hispanic ethnicity, and granular ethnicity data depends on the ways in which the questions are asked, the instructions provided to respondents (e.g., "Select one or more")
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. The subcommittee establishes a hierarchy among the possible language questions, with questions about English proficiency and preferred spoken language identified as a higher priority than questions on language spoken at home or on preferred language for written materials.
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. Recommendation 4-3: When any health care entity collects language data, the languages used as response options or categories for analysis should be selected from a national standard set of lan guages in use in the United States.
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Sign languages should be included in national lists of spoken languages and Braille in lists of written languages. • HHS should ensure that any national hierarchy used to roll up granular ethnicity catego ries to the broad OMB race and Hispanic ethnicity categories takes into account responses that do not correspond to one of the OMB categories.
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Recommendation 6-2: HHS, the Department of Veterans Affairs, and the Department of Defense should coordinate their efforts to ensure that all federally funded health care delivery systems col lect the variables of race, Hispanic ethnicity, granular ethnicity, and language need as outlined in this report, and include these data in the health records of individuals for use in stratifying qual ity performance metrics, organizing quality improvement and disparity reduction initiatives, and reporting on progress. Accreditation organizations and other professional and standards-setting bodies can play a key role in fostering the collection of race, ethnicity, and language data.
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as part of their accreditation standards and per formance measure endorsements. • The Joint Commission, NCQA, and URAC should ensure collection in individual health records of the variables of race, Hispanic ethnicity, granular ethnicity, and language need as outlined in this report so these data can be used to stratify quality performance metrics, organize quality improvement and disparity reduction initiatives, and report on progress.
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There is strong evidence that the quality of health care varies by race, ethnicity, and language. Quality metrics stratified by race, Hispanic ethnicity, granular ethnicity and language need can inform point-of-care services, application of resources, and decisions in patient–provider interactions in ways that can assist in improving overall quality and reducing disparities.
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Integrated Health Association. Presentation to the IOM Committee on Future Directions for the National Healthcare Quality and Disparities Reports, March 12, 2009.
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