Should quality data be collected by race, ethnicity?
Expert says it's important in analyzing disparities
At first glance, the thought of collecting and studying quality data by patient race and ethnicity might make one uncomfortable, but in fact, it's a powerful strategy for quality managers wishing to eliminate disparities in health care, asserts Bruce Siegel, MD, MPH, director, Urgent Matters National Program Office, George Washington University Medical Center, Washington, DC, and lead author of a study by The Commonwealth Fund entitled Enhancing Public Hospitals' Reporting of Data on Racial and Ethnic Disparities in Care.
The authors assert, in fact, that efforts to reduce disparities must be firmly tied to quality improvement efforts. However, as they observed while interviewing representatives from five public "safety net" hospitals, most clinical and QI leaders don't think of their initiatives from that perspective.
"I think they need to start doing that," Siegel says. "One thing we were struck by in our discussions with these hospitals is when you ask questions about disparities or equity, the first reaction is, 'We treat all of our patients the same; we believe in high quality for all.' But when we ask them, 'How do you know?' you don't get much of a response."
In other words, he continues, there's an assumption of equity with not a lot of data to support it. "That, in and of itself, tells me this is an area ripe for self-examination," Siegel asserts.
Why we should care?
Why does Siegel insist that equal care is an appropriate concern of quality professionals? "One of the six domains of quality in the [Institute of Medicine] publication Crossing the Quality Chasm is equity — every patient gets the care they deserve," he explains. "So a core domain of quality is equity. The second point is that more and more people are saying that disparities are evidence of some patients not getting high-quality care. After all, if every patient got the best care, there would be no disparities."
Part of the disparities issue, he continues, is that studies do find that hospitals treat different patients differently. "We saw a little bit of that in our study, which included communication measures," says Siegel. (The hospitals participating in the study used Hospital Quality Alliance [HQA] measures in collecting their data). "Part of what we find is that hospitals with a lot of minority patients do not provide optimal quality for any of their patients and have a real opportunity to improve across the board. So, it's a complicated picture on both sides of the story."
'Getting serious'
Siegel says he is starting to see more health care institutions collecting data by race and ethnicity. "We are now getting serious about collecting race data on patients; for example, it is now mandated by the state of New Jersey," he observes. "They are being trained how to do it in a uniform, standardized fashion."
Part of the impact of such data collection is that the hospital's quality staff will now be able to look at their data and see any disparity problems that exist, Siegel explains. "Also, they will start to know more about their patients in general. They will gain a better idea of how many patients need language services, or have different cultural beliefs and perspectives." Another important part is learning exactly who your customers are.
Siegel recognizes this is not an altogether easy process, as he has learned through his involvement in a disparities collaborative (www.expectingsuccess.org), in which all hospitals have been trained how to collect such data. He says so far there are two headlines coming out of his experience.
"There is some anxiety about doing this; some facilities are concerned that there are legal issues — which there are not," he says. In addition, he notes, "Some people are nervous about asking people these questions." What the collaborative has found, however, is there has really not been a big pushback.
"People are used to being asked these questions in a lot of situations," he observes. "Health care has really lagged behind other parts of our society in looking at these issues." For example, he notes, President Bush's "No Child Left Behind" program has schools report data by race and ethnicity. "Banks report mortgage lending by race and ethnicity; these requirements have arisen from a perceived issue of disparity," Siegel notes. "Health care lags behind, even though we know from thousands of studies that disparities are a real issue for health care."
Improved collection needed
Another take-home message of his study, says Siegel, is that collection methodology needs to be improved. While the participating hospitals used all the HQA pneumonia and heart care measures that were in place at the time, and with which the hospitals should have been familiar, "it was hard for some of them; they were not really set up [to collect data this way]," he observes. Some facilities were able to run some ad hoc reports, while many turned to outside vendors to help them.
"I think looking at the HQA measures could be worthwhile because some disparities may show up," he offers. Another important area of focus, he notes, is the entire area of transitions: How well prepared are the patients to return to the community? For example, is the patient prepared enough that they will be compliant with their home care? The only way to determine that, Siegel says, is ultimately to look at statistics such as heart failure readmission rates.
Siegel has no doubt this is a trend that will grow. "We've heard rumblings that CMS is looking at examining data by race, ethnicity, and language," he says. "This could be very telling."
For more information, contact:
Bruce Siegel, MD, MPH, Director, Urgent Matters National Program Office, George Washington University Medical Center, Washington, DC. Phone: (202) 994-8110. E-mail: [email protected].
At first glance, the thought of collecting and studying quality data by patient race and ethnicity might make one uncomfortable, but in fact, it's a powerful strategy for quality managers wishing to eliminate disparities in health care, asserts Bruce Siegel, MD, MPH, director, Urgent Matters National Program Office, George Washington University Medical Center, Washington, DC, and lead author of a study by The Commonwealth Fund entitled Enhancing Public Hospitals' Reporting of Data on Racial and Ethnic Disparities in Care.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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