Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care (2003) / Chapter Skim
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7. Data Collection and Monitoring
7. Data Collection and Monitoring
Pages 215-234
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From page 215... ...
Unfortunately, standardized data on racial and ethnic differences in care are generally unavailable. Federal, private, and state-supported data collection efforts are scattered and unsystematic, and many health plans, with a few notable exceptions, do not collect data on enrollees' race, ethnicity, or primary language, pointing to significant obstacles to the collection and analysis of such data (Perot and Youdelman, 2001~.
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From page 216... ...
, and is beyond the scope of this report. Selecting indicators of healthcare disparities that can be readily measured, analyzed and reported, and developing methods to ensure reliable data collection will require careful consideration of costs, benefits, and other potential problems inherent in collecting and reporting patient care data (see discussion of obstacles to racial/ethnic data collection, below)
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From page 217... ...
Efforts to enforce data collection from the federal level may also meet resistance from state authorities, who retain primary responsibility for determining data requirements of health plans with whom states contract for Medicaid MCO services. Federal efforts to require the collection of patients' racial and ethnic data would raise challenges from those who find federal reporting requirements already burdensome and the federal role in dictating the terms of managed care contracts too extensive.
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From page 218... ...
Many health plans, however, remain concerned that their ability to serve minority patients could be hampered should data collection efforts be seen by these populations as an effort to ration care. In addition, plans that serve disproportionately minority and lower-income populations could be hurt by the release of "report card" information that reveals their enrolled members to be less healthy or to require more services than the majority population.
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From page 219... ...
An important first step would involve an assessment of existing data sets within public and private plans that allows for an analysis of patient care by race and ethnicity. THE FEDERAL ROLE IN RACIAL, ETHNIC, AND PRIMARY LANGUAGE HEALTH DATA Several agencies of the DHHS, recognizing the importance of racial, ethnic, and primary language healthcare data, have attempted to promote data collection and monitoring efforts, particularly to address the challenges noted above.
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SHIRE and NHeLP analyzed 80 program-specific statutes and over 100 data collection vehicles, and developed 25 findings and 10 recommendations regarding federal data policies (Perot and Youdelman, 2001~. These recommendations are listed in Box 7-1.
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Second, a growing number of federal policies emphasizes the need for the collection of race, ethnicity, and primary language data. Third, such data is an indispensable tool for the assessment of progress toward federal goals of eliminating health disparities (U.S.
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From page 222... ...
The SHIRE-NHeLP report notes that two significant developments in early 2001 illustrate the "disconnect" between federal consensus and practice. In one instance, HHS finalized regulations regarding standard data elements for the electronic transmission of health information authorized under HIPAA, yet these rules failed to identify race or ethnicity as a required code, an omission that many HHS officials saw as a "lost opportunity." In another instance, HHS published regulations for Medicaid Managed Care and the State Child Health Insurance Program (SCHIP)
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From page 223... ...
As will be noted later in this chapter, data from these sources can be used to help identify sources of disparities in care and/or monitor changes in racial and ethnic disparities in care over time. The following summary of data collection systems is not intended as an exhaustive listing of federal, state, or privately funded data sets that may be used to assess racial and ethnic healthcare disparities.
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From page 224... ...
population. MEPS consists of four components: the Household Component, which samples families and individuals to assess health status, insurance coverage, healthcare use and expenditures, and sources of payment for health services; the Nursing Home Component, which samples nursing homes and residents to assess characteristics of facilities and services offered, costs, and sources of payment of these services; the Medical Provider Component, which supplements information from the Household Component by surveying hospitals, physicians, and home healthcare providers; and the Insurance Component, which assesses the amount, types, and costs of health insurance available to employees.
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From page 225... ...
HEDIS also includes a standardized survey of consumers' experiences that evaluates plan performance in areas such as customer service, access to care and claims processing. At the state level, new data sets being developed, such as the California Health Interview Survey (CHIS)
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From page 226... ...
In another federal initiative, AHRQ has initiated plans to develop a national report on racial and ethnic disparities in healthcare, and plans to incorporate measures of racial and ethnic disparities in care in a national report of quality of care. Within the private sector, the National Quality Forum (NQF)
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1~. In this review, the authors note that the existence of racial and ethnic disparities in healthcare does not necessarily reflect discrimination, but focus their analysis on indicators that may detect patterns of discrimination apart from disparities that are not inherently discriminatory.
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From page 228... ...
Extended postoperative stay as a means of assessing multiple aspects of CABG care 11. Intrahospital mortality as a means of assessing multiple aspects of PTCA care 12.
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From page 229... ...
"Health Accountability 36," patient assessments, administrative claims audits, and assessments of substandard care. The "Health Accountability 36" measures draw largely upon existing data, and can be applied to geographically defined populations, individuals in health plans, and hospital and clinic patients.
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From page 230... ...
Both involve an initial screening of potentially problematic cases, typically by two trained healthcare professionals, but screening methods differ in that one approach utilizes actual medical records, while the other uses administrative claims data. Such analysis could indicate whether minority patients are differentially more or less likely to face substandard care.
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From page 231... ...
Health plans voluntarily report this information to NCQA, which then disseminates data as part of its Quality Compass database in regular publications such as the NCQA State of Managed Care Quality report. Quality Compass 2000 contains measures of plan performance in several clinical areas, such as cancer screening, childhood and adult immunization, timely outpatient care, and evidence-based treatments for hypertension, cardiovascular disease, asthma, diabetes, and depression.
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From page 232... ...
notes, "Effective data collection is the linchpin of any comprehensive strategy to eliminate racial and ethnic disparities in health." Currently, data collection efforts are unsystematic and inadequate to monitor the quality of care provided to racial and ethnic minorities. These efforts must be improved to ensure accountability of plans and providers to healthcare payors and consumers, to track disparities and assess the impact of quality improvement efforts, and to identify best practices that may be replicated by other plans and health systems.
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From page 233... ...
Such a long-term goal will require federal leadership and financial support. Recommendation 7-1: Collect and report data on healthcare access and utilization by patients' race, ethnicity, socioeconomic status, and where possible, primary language.
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The secretary of HHS should conduct periodic studies to monitor the nation's progress toward eliminating racial and ethnic healthcare disparities, to provide insight into the root causes of these disparities, and to assess opportunities for intervention and improvement. Recommendation 7-4: Report racial and ethnic data by OMB categories, but use subpopulation groups where possible.
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