Obtaining data on patient race, ethnicity, and primary language in health care organizations: current challenges and proposed solutions

Health Services Research, August, 2006 by Romana Hasnain-Wynia, David W. Baker

Responding to Communities and Providing Patient-Centered Care

Communities want HCOs to be accountable and responsive to them. According to the American College of Physicians (ACP) position paper on racial and ethnic disparities in health care "an ongoing dialogue with surrounding communities can help a HCO integrate cultural beliefs and perspectives into health care practices and health promotion activities"(2004). Further, effectively managing the health care of patients and using culturally appropriate care improves the health of communities (ACP 2004).

Tracking the racial/ethnic and language composition with concurrently changing health care needs of communities is vital if HCOs are to fulfill their functions. Race/ethnicity and linguistic norms contribute to the definition of what symptoms are noteworthy and how symptoms are presented (Bartlett et al. 1984). As HCOs strive to develop systems and practices that ensure care of all patients is truly patient-centered, understanding the racial/ethnic and language contexts of their patient population is vital.

Accurate information on patients' race, ethnicity, and language is essential to ensure the adequacy of interpreter services, patient information materials, and cultural competency training for staff. Ideally, this information can also be linked to quality measures to examine disparities and undertake targeted quality improvement programs to eliminate disparities. For example, a study of 58,700 randomly selected hemodialysis patients showed that improving the process of care and targeted quality improvement efforts can reduce disparities (Sehgal 2003). However, it was also notable in this study that there was a reduction in disparities in two of the measures that mainly reflected changes in physician behavior. However, this reduction in race disparity was not seen in another measure that was more dependent on patient behavior. This finding underscores the importance of self-identified race/ethnicity and the unique cultural and behavior aspects related to it. This information can help HCOs identify and understand when to implement more generic quality improvement initiatives versus more culturally appropriate and targeted quality improvement interventions to specific patient subgroups.

Mandates and Accreditation

External directives, ranging from federal and state reporting requirements to accreditation, also require the collection of these data. The Center for Medicare and Medicaid Services (CMS) has implemented policies to use race and ethnicity data for quality improvement purposes. For example, peer review organizations in all 50 states contract with CMS to assess and promote quality of health services and have been charged with reducing disparities. Under the Medicare Choice Quality Assessment Performance Improvement project, managed care plans are required to identify racial and ethnic disparities in clinical outcomes. Some state strategies for Medicaid managed care quality assessment and improvement ask for the inclusion of race, ethnicity, and language data (Perot and Youdelman 2001).