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6 Implementation
Pages 147-162

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From page 147... ... Recognizing the need for more detailed data on race, ethnicity, and language to support improvements in health and the quality of health care, the subcommittee recommends combining the use of granular ethnicity categories with the broad OMB categories, as well as an assessment of a patient's language need (whether a person's spoken English proficiency is less than "very well," and what is his/her preferred spoken language for effective communication during healthrelated encounters) Read the entire page →
From page 148... ... Templates for national lists of granular ethnicity and language categories are provided in Appendixes E and I, respectively. These templates can serve as building blocks upon which HHS can develop and maintain comprehensive national standard lists of granular ethnicities and languages based on the experiences of participants in health care delivery and quality improvement. Read the entire page →
From page 149... ... , 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. Read the entire page →
From page 150... ... HHS should develop national standard sets of granular ethnicity and language categories with a responsive updating process and associated coding, so that each state or entity would be relieved of having to develop its own category sets and coding schemes. Data would then have a greater likelihood of being compatible across entities. Read the entire page →
From page 151... ... • 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. Electronic Health Records The American Recovery and Reinvestment Act of 2009 (ARRA) Read the entire page →
From page 152... ... should adopt as standards for including in electronic health records the vari ables of race, Hispanic ethnicity, granular ethnicity, and language need identified in this report. Recommendation 6-1c: HHS and ONC should develop standards for electronic data transmission among health care providers and plans that support data exchange and possible aggregation of race, Hispanic ethnicity, granular ethnicity, and language need data across entities to minimize redundancy in data collection. Read the entire page →
From page 153... ... HHS administers programs supporting the health care delivery system to provide care to persons at risk of receiving suboptimal care, and these programs present opportunities to influence the quality of care delivered to millions of Americans. For example, at least a 100 million of the 300 million people in the country are served by just three programs administered by HHS -- Medicare, Medicaid, and community health centers.11 Ensuring the quality of care to its programmatic participants is an HHS priority, and HHS lead ership can make a difference in the adoption of this report's recommendations as it responds to recent legislation to ensure the use of race, ethnicity, and language data in assessing quality of care and building a national health information network (HHS, 2009c) Read the entire page →
From page 154... ... The subcommittee's task was to recommend standardization of race, ethnicity, and language data for use in health care quality improvement. Thus, the following recommendation focuses on the HHS programs that deliver health care services, pay for health care services through insurance mechanisms, or administer surveys that increase the knowledge base on health care needs and outcomes. Read the entire page →
From page 155... ... include data on race, Hispanic ethnicity, granular ethnicity, and language need in individual health records so these data can be used to stratify quality performance metrics, organize quality improvement and disparity reduction initiatives, and report on progress. COORDINATION ACROSS FEDERAL HEALTH CARE DELIVERY SYSTEMS The Department of Veterans Affairs (VA) Read the entire page →
From page 156... ... It is expected that the module will address the use of race, ethnicity, and language data in stratifying quality performance data to identify both disparities in health care and problems in meeting language needs, as well as the use of those findings to drive quality improvement. Currently, NCQA has a program that rewards health plans for demonstrating innovative practices in providing for culturally and linguistically appropriate services (NCQA, 2006, 2007, 2008b) Read the entire page →
From page 157... ... 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. Read the entire page →
From page 158... ... Recommendation 6-4: Through their certification, regulation, and monitoring of health care pro viders and organizations within their jurisdiction, states should require the collection of data on the race, Hispanic ethnicity, granular ethnicity, and language need variables 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. Although it was beyond the scope of the subcommittee's deliberations to determine the extent of the need, representatives of state data agencies noted that one of the greatest barriers to state health departments, Medicaid agencies, and regulatory agencies in fulfilling responsibilities related to certification, regulation, and monitoring activities has been the lack of funding to expand and improve state data collection activities. Read the entire page →
From page 159... ... These responses can help identify when additional categories may need to be added to prespecified lists on data collection instruments. Many actors play a role in health care delivery and quality assessment, and each has a role to play in further ing the collection of meaningful race, ethnicity, and language data for quality improvement. Read the entire page →
From page 160... ... Presentation to the IOM Committee on Future Directions for the National Healthcare Quality and Disparities Reports, February 10, 2009. Washington, DC. Read the entire page →
From page 161... ... Integrated Health Association. Presentation to the IOM Committee on Future Directions for the National Healthcare Quality and Disparities Reports, March 12, 2009. Read the entire page →

From page 147...

... Recognizing the need for more detailed data on race, ethnicity, and language to support improvements in health and the quality of health care, the subcommittee recommends combining the use of granular ethnicity categories with the broad OMB categories, as well as an assessment of a patient's language need (whether a person's spoken English proficiency is less than "very well," and what is his/her preferred spoken language for effective communication during healthrelated encounters)

6 Implementation Pages 147-162

6 Implementation
Pages 147-162