Transcript Literacy and Cost

OVERVIEW
Collecting Race, Ethnicity, and
Primary Language Information:
A Foundation for Improving Quality of
Care for Diverse Populations
INSERT YOUR NAME
INSERT NAME OF YOUR
ORGANIZATION
INSERT DATE
© 2007 by the Health Research and Educational Trust
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Question
HOW to collect relevant data to
answer the following questions:
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WHY and HOW disparities occur
Which interventions are effective at reducing
or eliminating disparities
What proportion of observed disparities are
amenable to improvements in health care
What We Know: Disparities in
Care Are a National Problem
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African Americans are:
– Less likely to have a kidney transplant,
surgery for lung cancer, bypass surgery
– More likely to have a foot amputation
– More likely to die prematurely
Latinos/Hispanics are:
– Less likely to receive pain medications
Chinese? Pakistanis? Croatians? Iranians?
CHANGING DEMOGRAPHICS:
CHANGING NEEDS
Demographic Changes
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The U.S. population grew by 13% between 1990 and 2000.
(Andrulis et al. 2003)
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Foreign-born population living in the US increased by 44%
to 28.4 million people during this period. (U.S. Census Bureau
2002).
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In 2000, the foreign-born population comprised 10 percent of
the total population, its highest since 1930. (U.S. Census Bureau
2002)
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Over 300 different languages are spoken in the U.S. and nearly
47 million people (18% of the U.S. population) speak a language
other than English at home. (U.S. Census Bureau 2003)
Demographics of Your
Community
INSERT INFORMATION
-How has it changed
-Can you track it
To Improve Quality of Care for Diverse
Populations: Collect Data
• Quality of care can be hindered because
of bias and prejudice
• Quality of care can be hindered because
of communication, language, or cultural
barriers
Health Care Disparities Are a
Health Care Quality Issue
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Measures of health care disparities are
quality measures.
We can use quality improvement tools and
techniques to address health care
disparities.
But quality measures are not necessarily
health care disparity measures unless you
stratify by race, ethnicity, language.
Internal Reasons to Collect Data
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Identifying differences in care and developing targeted
interventions
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Being responsive to communities: Pressing community health
problems such as disparities in care can be addressed more
effectively if health care organizations and health professionals
build the trust of the community by documenting
accomplishments
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Linking race and ethnicity information to quality measures to
examine disparities and undertake targeted interventions
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Ensuring the adequacy of interpreter services, patient information
materials, and cultural competency training for staff
External Reasons to Collect Data
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Reporting to the Joint Commission on
Accreditation of Healthcare Organizations
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Reporting to CMS (payer, purchaser
regulator, insurer, works through QIOs)
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State mandates
Your Hospital or HCO
Initiatives
Insert initiatives your organization is
undertaking to:
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Reduce disparities/improve quality of care for
diverse populations
Barriers to Collecting Data
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Validity and reliability of data
Legal concerns (It is legal to collect!)
System/organizational barriers
Appropriate categories
Patients’ perceptions/language and
culture
Staff discomfort in explicitly asking
patients to provide this information
Recommendations for Standardization
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Who provides the information—should always be patients or their
caretakers. Should never be done by observation alone.
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When to collect—upon admission or patient registration to ensure
appropriate fields are completed when patient begins treatment
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What racial and ethnic categories should be used—start with the OMB
categories. Hospitals can provide more “fine-grained” categories if
needed.
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Where should data be stored—in a standard format for easy linking to
clinical data.
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Patient concerns—should be addressed upfront and clearly prior to
obtaining information.
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Staff training—need to provide ongoing training and evaluation.
© 2007 by the Health Research and Educational Trust
What is the purpose of staff
training?
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To implement an efficient, valid, and reliable
method of collecting information about
patients’ racial/ethnic background and primary
language that is acceptable to patients and
staff
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To provide registration/admission staff with
information and tools they can use
Patients Are Comfortable
Providing Information
When they are given a reason for
why it is being collected
Results from a study at Northwestern Memorial
Hospital in Chicago showed that Most Patients
Agreed That It Is Important to Collect Race/Ethnicity
Data
“It is important for hospitals & clinics to collect
information from patients about their race or
ethnic background.” Would you say that you:
Strongly Agree
Somewhat Agree
Unsure
Somewhat Disagree
Strongly Disagree
43%
37%
6%
10%
4%
Baker DW, Cameron KA, Feinglass J, Georgas P, Foster S, Pierce D, Thompson J, Hasnain-Wynia R. “Patients’ Attitudes Toward Health
Care Providers Collecting Information About Their Race And Ethnicity.” J Gen Intern Med. Vol 20 (10). October 2005.
Even Stronger Support that Hospitals
Should Examine Differences in Quality
“It is important for hospitals and clinics to conduct
studies to make sure that all patients get the same high
quality care regardless of their race or ethnic
background.” Would you say that you:
Strongly Agree
Somewhat Agree
Unsure
Somewhat Disagree
93%
4%
2%
1%
Baker DW, Cameron KA, Feinglass J, Georgas P, Foster S, Pierce D, Thompson J, Hasnain-Wynia R. “Patients’ Attitudes Toward Health
Care Providers Collecting Information About Their Race And Ethnicity.” J Gen Intern Med. Vol 20 (10). October 2005.
Significant Concerns About How
This Data Might Be Used
“How concerned would you be that this data
could be used to discriminate against
patients?”
Not concerned at all
A little concerned
Somewhat concerned
Very concerned
34%
15%
20%
31%
Baker DW, Cameron KA, Feinglass J, Georgas P, Foster S, Pierce D, Thompson J, Hasnain-Wynia R. “Patients’ Attitudes Toward
Health Care Providers Collecting Information About Their Race And Ethnicity.” J Gen Intern Med. Vol 20 (10). October 2005.
Can we decrease patients’ concerns
about collecting this information by
providing the rationale for why we are
collecting this information?
Four possible rationales for collecting
race/ethnicity:
#1 – Monitoring quality of care (“monitoring”)
#2 – Mandate to collect information (“mandate”)
#3 – Staff training and hiring (“needs assessment”)
#4 – Possible benefits for one’s care (“personal gain”)
.
“Monitoring”rationale helps
patients feel the most comfortable
“We want to make sure that all our patients
get the best care possible. We would like you
to tell us your race or ethnic background so
that we can review the treatment that all
patients receive and make sure that everyone
gets the highest quality of care.”
Introducing Topic to Patients:
State Rationale Before Asking
the Question
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“We want to make sure that all our patients get the
best care possible. We would like you to tell us your
race or ethnic background so that we can review the
treatment that all patients receive and make sure that
everyone gets the highest quality of care.”
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If you want to collect more granular information,
add: “You can use general terms such as White,
African-American, Latino, or Asian or you can use
more specific terms like Irish, Mexican, Hawaiian, or
Navajo. You can use more than one term if you like.”
Why Should We Collect This
Information?
1.
2.
3.
4.
5.
Monitor quality of care.
Design innovative programs to eliminate
disparities and rigorously test them.
Know our patients so we can better meet
their needs and show communities that we
deliver the best care possible to them.
Satisfy JCAHO, CMS, etc.
Take a national leadership position and
show other hospitals and HCOs what is
possible.
“….But We Already Collect This
Information!”
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That may be true, but here (next set of
slides) are results of a national study that
examined race, ethnicity, and primary
language data collection in hospitals.
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The study shows that even if we are
collecting it, we are not doing a good job.
Data Collection in Hospitals
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The majority of hospitals report that they collect race data
(78%-82%). Many do not collect ethnicity data.
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Fifty-eight percent (58%) indicated that more than one unit
or clinic within the hospital collect data.
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Majority collect it by observing the patient and guessing.
Source: Who, When, and How: The Current State of Race, Ethnicity, and Primary Language Data Collection
in Hospitals, Romana Hasnain-Wynia, Debra Pierce, and Mary A. Pittman, The Commonwealth Fund, May 2004
100
80
Are Hospitals Collecting
96
95
Race/Ethnicity
Data?
89
75
70
60
40
31
20
0
Source: Who, When, and How: The Current State of Race, Ethnicity, and Primary Language Data Collection in Hospitals, Romana
Hasnain-Wynia, Debra Pierce, and Mary A. Pittman, The Commonwealth Fund, May 2004
Little Uniformity in Methods for
Collecting Data
Admitting clerk obtains
information from patient.
68%
Patient self-identifies on form.
65%
Admitting clerk records based on
observation.
51%
Health care provider obtains from
patient.
19%
Health care provider records
based on observation.
12%
Source: Who, When, and How: The Current State of Race, Ethnicity, and Primary Language Data Collection in Hospitals,
Romana Hasnain-Wynia, Debra Pierce, and Mary A. Pittman, The Commonwealth Fund, May 2004
Little Uniformity in Categories for
Collecting Data
White/Caucasian
95%
Black/African American
94%
Spanish/Hispanic/Latino
81%
American Indian
78%
Asian
78%
Source: Who, When, and How: The Current State of Race, Ethnicity, and Primary Language Data Collection in Hospitals,
Romana Hasnain-Wynia, Debra Pierce, and Mary A. Pittman, The Commonwealth Fund, May 2004
Staff Training Will Provide the
Following
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Toolkit
Scripts
Categories
How to address concerns from patients