Race, Ethnicity, and Language Data Standardization for Health Care Quality Improvement (2009) / Chapter Skim
Currently Skimming:
3 Defining Categorization Needs for Race and Ethnicity Data
3 Defining Categorization Needs for Race and Ethnicity Data
Pages 61-92
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 61... ...
Collection of data in the OMB race and Hispanic ethnicity categories, supplemented by more granular ethnicity data, is recommended, with tailoring of the latter through locally relevant categories chosen from a standardized national set. In most cases, rolling up the data on granular ethnicities to the OMB categories will be possible, but it will be necessary to exercise care as there are certain ethnicities that do not correspond with any one race.
|
From page 62... ...
considering how the OMB race and Hispanic ethnicity categories can be combined with locally tailored, more detailed ethnicity categories selected from a national standard set, with standardized coding and rollup procedures, to capture important variations among ethnic groups. The chapter concludes by exploring approaches to eliciting responses on race, Hispanic ethnicity, and granular ethnicity, and reviewing models for data collection.
|
From page 63... ...
. These surveys collect race and Hispanic ethnicity data in the six categories specified by OMB and a usually common set of 9 to 12 additional ethnicity categories.
|
From page 64... ...
X X North American Indian or Alaskan X Native ethnicity format race and Hispanic American Indian/Alaskan Native X Responses to combined White (Not Hispanic) X X Yes/Hispanic or Latino X X X X X X No/Not Hispanic or Latino/Not of X X X X X X X X X Spanish, Hispanic, Latino origin Puerto Rican X X X X X X X Cuban/Cuban American X X X X X X X Dominican (Republic)
|
From page 65... ...
DEFINING CATEGORIZATION NEEDS FOR RACE AND ETHNICITY DATA 3-29 Application Minimum Certificate of Census Categories Collected NHIS NIS NSDUH MEPS NAMCS NHAMCS for a SSN Data Set Birth and Death SEER 2010 White X X X X X X X X X Black/African American X X X X X X X Black X Black, African Am., or Negro X American Indian X X Alaska Native X X American Indian or Alaska Native X X X X American Indian or Alaska Native – Print X X name of enrolled or principal tribe American Indian, Aleutian, Alaskan Native, X or Eskimo Native Hawaiian X X X X X X Native Hawaiian or Other Pacific Islander X X X Samoan X X X X Guamanian or Chamorro X X X X Micronesian X Polynesian X Tahitian X Tongan X Melanesian X Fiji Islander X New Guinean X Other Pacific Islander, Specify X X X X X X Asian X X X X X Asian Indian X X X X X Asian Indian, Pakistani X Chinese X X X X X X Responses to race question in two-question format Filipino X X X X X X Japanese X X X X X X Korean X X X X X X Vietnamese X X X X X X Other Asian: Specify X X X X X X Laotian X Hmong X Kampuchean (including Khmer and X Cambodian) Thai X Some other race, Specify X X X X X X X Refused X X X Don't know/Unknown X X X X 6
|
From page 66... ...
. Vital Statistics Data Failure to use standard categories and nonreporting or misreporting of data complicate efforts to calculate national and state birth, mortality, and morbidity rates by the OMB race and Hispanic ethnicity categories or for more detailed categories.
|
From page 67... ...
b Using (out of 38) c Ethnicity Categories White 20 32 37 American Indian or Alaska Native 20 31 37 Black or African American 19 32 37 19d 32e 35f Hispanic or Latino Asian 16 32 37 Native Hawaiian or Other Pacific Islander 14 30 36 Other 9 5 8 a SOURCE: Palmer, 2004.
|
From page 68... ...
Program coding manual includes two of the OMB categories directly (e.g., White and Black) and more granular ethnicity categories that correspond to the other OMB standard categories (e.g., instead of a broad Hispanic ethnicity category, SEER asks more specifically whether a person is Puerto Rican or Cuban)
|
From page 69... ...
CONTINUED USE OF THE OMB CATEGORIES The OMB race and Hispanic ethnicity categories were deemed to represent the country's broad population groups most necessary or useful for a variety of reporting and analytic purposes not specific to health care. The 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity were developed over a 4-year period during which an interagency taskforce weighed public input, expert testimony, and other evidence to consider whether and how to modify OMB's 1977 standards (OMB, 1977, 1997b)
|
From page 70... ...
, as well as more local uses. If all entities were to collect race and ethnicity data using the OMB categories, the process of combining or comparing data across reporting entities (e.g., hospitals in states contribut ing to HCUP or health plans' Healthcare Effectiveness Data and Information Set [HEDIS]
|
From page 71... ...
Mark � one or more races to indicate what this person considers himself/herself to be. White Black, African Am., or Negro American Indian or Alaska Native -- Print name of enrolled or principal tribe.
|
From page 72... ...
. As previously stated, the OMB standards encourage, "whenever feasible," the separation of questions on race and Hispanic ethnicity, a distinction stemming from a 1976 law requiring documentation of the size and growth of the Hispanic population.10 Some research prior to the 1997 OMB revisions indicated that the separate, twoquestion format in which Hispanic ethnicity is elicited before race11 best identifies an OMB race category for as many Hispanic individuals as possible and allows analyses of combined race and Hispanic ethnicity categories (e.g., Hispanic Black and non-Hispanic Black)
|
From page 73... ...
introduced bills HR 2071 and SB 1083, respectively, to include a Caribbean check-off box on all future Census forms. These efforts indicate a continued call for more detailed ethnicity data.
|
From page 74... ...
NEED FOR LOCALLY RELEVANT GRANULAR ETHNICITY CATEGORIES As noted earlier, the OMB categories, when used alone, can mask important within-group variations in qual ity of care (Blendon et al., 2007; Jerant et al., 2008; Read et al., 2005; Shah and Carrasquillo, 2006)
|
From page 75... ...
Similarly, a health care provider may care for a large number of persons who belong to an ethnic group whose significant presence is masked even by county-level data in the aggregate OMB categories. Ethnicity Categories on Data Collection Instruments Health care entities must determine an approach to collecting granular ethnicity data that allows all individuals, if they desire, to self-identify and at the same time is feasible, given that the population of their service area may include hundreds of granular ethnicities.
|
From page 76... ...
But open-ended questions may have advan tages for some entities collecting granular ethnicity data, including that this format reduces the amount of space needed on paper data collection forms or electronic screens. However, collecting open-format data for hundreds of thousands of enrollees or respondents on a survey can make it difficult to use the data unless resources are devoted to coding those responses according to standardized categories.
|
From page 77... ...
, none of these include all of the granular ethnicity categories required for a national set. Merging these sets, as is done in Appendix E, provides a starting point from which a national standard set could be developed.
|
From page 78... ...
206 additional ethnicities Wisconsin Cancer Reporting System 648 categories 371 American Indian or Alaska Native categories Code Manual (2008) 129 White categories 37 Black or African American categories 41 NHOPI categories 14 Other Race categories Contra Costa Health Plan Race and 143 categories 130 categories from the CDC/HL7 Code Set Ethnicity 9 additional ethnicity categories: American, Bosnian, Brazilian, Kurdish, Mixtec, Portuguese, Punjabi, Russian, and Yao, Mien NOTE: The estimated categories in the third column may not equal the total number of categories in the middle column due to additional response and coding options such as Unknown, Declined, and Unavailable.
|
From page 79... ...
After implementation, Kaiser determined a need for more granular ethnicity categories to allow for better self-identification and analyses of health care data. As a result, Kaiser developed a list of granular ethnicities that could be used for self-reporting separately from the OMB race and Hispanic ethnicity categories.
|
From page 80... ...
and 61 additional ethnicity categories considered most pertinent to its enrollees. 18 As all granular ethnicity lists should also include an "Other, please specify:__" option, the write-in responses may help organizations evaluate and expand as necessary the granular ethnicity response options provided.
|
From page 81... ...
• Elicit categorical responses consistent with the current OMB standard race and Hispanic ethnicity categories, with the addition of a response option of "Some other race" for per sons who do not identify with the OMB race categories. Consistent Rollup of Granular Ethnicity to OMB Categories While systems for rolling granular ethnicity categories up to broader categories have been developed by CDC/HL7 and the Commonwealth of Massachusetts, among others, an agreed-upon rollup strategy for granular ethnicities has not been determined or reviewed for its applicability nationwide and across the health care system.
|
From page 82... ...
are five English Iranian Belearic Islander Salvadoran C ensus non- Spanish French Iraqi groups Gallego Central American Indian speaking German Lebanese Afghanistani Valencian Canal Zone territories with its Irish Palestinian Spanish Basque Argentinean (Brazil, Guyana , geographically Italian Afghanistani Mexican Bolivian Suriname, based Polish Israeli Asian French Guiana , Mexican American Colombian Scot tish Arab category and B elize ) Mexicano Ecuadorian Syrian Middle Eastern Chicano Paraguayan or North African La Raza Peruvian Mexican Uruguayan Black or Criollo Venezuelan African American Latin American South American Puer to Rican Indian Black Bahamian Many American Indian or African American Barbadian Dominicans Alaska Native African Dominican consider Botswanan Dominica Islander themselves Over 80 0 defined tribal groupings Ethiopian Haitian Hispanic, Liberian Jamaican not Black Namibian Tobagoan Nigerian Trinidadian Zairean West Indian FIGURE 3-3 CDC ethnicities rolled up to the OMB minimum categories for race and Hispanic ethnicity with subcommittee annotations.
|
From page 83... ...
The difficult-to-categorize granular ethnicity groups are included in Appendix F The subcommittee suggests that those ethnicities that do not meet the 90 percent threshold be classified as "no determinate OMB race classification." This classification differs from the "Some other race" category because "Some other race" is a response option used by individuals who do not identify with a specific OMB race category.
|
From page 84... ...
Recommendation 3-2: Any entity collecting data from individuals for purposes related to health and health care should collect granular ethnicity data in addition to data in the OMB race and Hispanic ethnicity categories and should select the granular ethnicity categories to be used from a national standard set. 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.
|
From page 85... ...
MODELS FOR DATA COLLECTION Figure 3-4 shows models for the collection of data on race, Hispanic ethnicity, and granular ethnicity, taking into account that the capacity of information systems may limit the number of questions that can be asked. This report emphasizes the importance of collecting granular ethnicity data in addition to the OMB race and Hispanic ethnicity questions.
|
From page 86... ...
first Recommended forms for the instruction are "Mark one Response options: Hispanic or or more" and "Select one or Latino, Not Hispanic or Latino more" Response options: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander (NHOPI) , White Census 2000 long form Is Person 1 of Hispanic, What is Person 1's race?
|
From page 87... ...
The granular ethnicity question, whether presented as a closed- or open-ended question, should be separate from the question(s) involving the OMB categories.
|
From page 88... ...
Response Categories: Response Categories: Locally relevant list of categories selected from a Black or African American national standard set White Other, please specify:__ OR Asian Open-ended question with responses coded from a American Indian or Alaska Native national standard set Native Hawaiian or Other Pacific Islander Some other race Granular Ethnicity Question Example Questions: What is this person's ancestry or ethnic origin? (Source: Census)
|
From page 89... ...
2008. Methods for improving cancer surveillance data in American Indian and Alaska Native populations.
|
From page 90... ...
2007. Agreement between self-reported and administrative race and ethnicity data among Medicaid enrollees in Minnesota.
|
From page 91... ...
1989. American Indians: The first of this land.
|
From page 92... ...
Pre sentation to the IOM Committee on Future Directions for the National Healthcare Quality and Disparities Reports, February 9, 2009. Washington, DC.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.