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May 18, 2004

Hospitals Can Do More to Collect Data on Patient Race, Ethnicity and Language

Standardization Would Better Support Efforts to Eliminate Health Care Disparities

New York City, May 18, 2004—A majority of hospitals collect information on patients' race, ethnicity, and primary language. But the collection methods and the accuracy of the information vary widely, pointing to the need for standardization to achieve more valid and useful data, a new Commonwealth Fund report says. Hospitals collect the data for a variety of reasons, including quality improvement and community relations efforts, because they are required to by law and to ensure availability of interpreter services. The report concludes that hospitals' efforts to collect these data is crucial to eliminate the well-documented disparities in health care experienced by patients who are members of minority populations or whose primary language is not English. "The recent announcement by Secretary of Health and Human Services Tommy Thompson that the federal government will implement a national Electronic Medical Record system within ten years points to the urgent need to standardize collection of racial, ethnic and language data in our health care system," said Commonwealth Fund senior program officer Anne C. Beal, M.D. "Having accurate, usable race and ethnicity data as part of this nationwide system will be essential to monitoring the quality of care and addressing the persistent health care disparities in our system." Who, When, and How: The Current State of Race, Ethnicity, and Primary Language Data Collection in Hospitals, by Romana Hasnain-Wynia, Debra Pierce, and Mary A. Pittman of the Health Research and Educational Trust (HRET) is based on site visits to six leading hospitals and health systems and a nationwide survey of hospitals. The researchers found that hospitals in the 22 states with a mandate to collect race and ethnicity data were more likely to do so than hospitals in the 28 states with no such mandate. Teaching hospitals and urban hospitals were also more likely to collect data on race, ethnicity, and primary language of patients. Based on their findings the authors recommend steps hospitals should take to ensure collection of accurate and useful data on the race, ethnicity, and primary language of their patients:

  • Hospitals should standardize who provides information; patients or caretakers are more likely to provide accurate information than hospital staff.
  • Data should be collected upon admission or patient registration.
  • Hospitals should standardize which racial or ethnic categories are used; the Office of Management and Budget (OMB) categories would be most useful in general, with specific hospitals using subcategories relevant to their location. The OMB categories for race are American Indian/Alaska Native; Asian; Black/African American; Native Hawaiian/Other Pacific Islander; and White. The categories for ethnicity are Hispanic or Latino; and Not Hispanic or Latino.
  • Data should be stored in a standard format that is compatible across hospitals and health systems, and that allows for export and import and merging with clinical data files.
  • Patients' concerns about how data will be used should be addressed before collecting the information.
Hasnain-Wynia presented findings from the report and discussed their importance to efforts to eliminate disparities in health care at a forum held Tuesday, May 18th at Harvard University. The "Roundtable on Racial and Ethnic Disparities in Health Care Treatment" was co-sponsored by the Civil Rights Project and the Program for Health Systems Improvement, both at Harvard, and organized with support from The Commonwealth Fund.

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May 18, 2004