Collecting Race, Ethnicity, and Primary Language Information: Why and How?

Transcription

1 Collecting Race, Ethnicity, and Primary Language Information: Why and How? A presentation to FPA clinics April 26, 2010 Sandra Eliason, M.D. Center for Cross Cultural Health 2007 by the Health Research and Educational Trust

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3 Data: A Foundation for Improving Quality of Care for Diverse Populations

4 Today s Objectives: Provide a rationale for race and ethnicity data collection Create a framework for data collection Present data collection how-to Answer questions about process Create a preliminary work plan Provide the tools needed for successful implementation

5 A Look at the Why : Changing demographics Health disparities

6 In the 2006 community survey, Minnesota was one of the least diverse states in the nation U.S. percent minority 33 MN percent minority 14

7 However, Nonwhite and Latino Populations are Growing Faster than the White Population. Over 60% of population growth this decade has been minority.

8 Minnesota Population Change by Race and Ethnicity, Latino 29 Two or more races Asian/Pacific Islander American Indian 7 Black Nonwhite/Latino White, not Latino 2 Total Population 4 % change, 2000 to 2005 U.S. Census Bureau estimates. American Indian includes Alaska native. Race alone data, except for two+ races. Latinos may be any race.

9 MN Growth Projections for Next 8 Years Nonwhite population 35 % Latino 47 % White population 7 % MN Dept. of Administration

10 Younger Are More Diverse % Nonwhite or Latino in Minnesota, Age U.S. Census Bureau estimates

11 Minnesota Legal Immigrants in 2005: 15,456 Department of Homeland Security data 2005 Number Somalia Ethiopia India Liberia Mexico China Vietnam Russia Kenya All others 1, ,223 7,416

12 Minnesota Legal Immigrants in 2009: 18,020 Department of Homeland Security ,013 1,159 1,614 4,173

13 Minnesota s Foreign-Born Population at highest level since , , , , , , , , ,878 98, , , Decennial Census; American Community Survey; 2005 data based on household population only.

14 Majority/Minority population change pattern , U.S. Census Bureau estimates 1: Total up, Minority up, Majority up 2: Total up, Minority up, Majority down 3: Total down, Minority up, Majority down Long Prairie Willmar Other Pattern Type Minority=Nonwhite and/or Latino Majority=White and Not Latino Austin

15 National Health Care Disparities Report: 2009 report the seventh National Healthcare Disparities Report mandated by the U.S. Congress; Produced by the Agency for Healthcare Research and Quality (AHRQ) on behalf of the U.S. Department of Health and Human Services (HHS) in collaboration with an Interagency Work Group

16 Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States. - Definition from the National Institutes of Health

17 2009 National Healthcare Disparities Report Disparities related to race, ethnicity, and socioeconomic status still pervade the American health care system

18 Quality Disparities in effectiveness, patient safety, timeliness, and patient centeredness. Access to care facilitators and barriers to care and health care utilization. Types of care preventive care, acute conditions, chronic disease Multiple areas clinics, hospitals, primary care, specialty care

19 For many measures, racial and ethnic minorities and poor people receive lower quality care: For Core Measures: Category Worse care Better care Blacks 50% 15% Asians 30% 40%. American Indians and Alaska Natives (AI/Ans) 45% 25% Hispanics 70% 20%. Poor people 75% 5%

20 Many Disparities Are Not Decreasing For Blacks, Asians, and Hispanics, at least two-thirds of measures of quality of care are not improving For Blacks, only about 20% of measures of disparities in quality of care improved. For poor people, disparities are improving for only half of the quality measures. For AI/ANs, approximately 40% of disparities in quality improved National Healthcare Disparities Report

21 Minnesota Disparities, 2006 Cardiovascular disease-- >10% higher in African Americans, Latinos, and American Indians than in whites. African Americans die from heart disease nearly 30% more often than whites. White women have the highest incidence of breast cancer, but African American women are most likely to die from it. Asian Americans are more likely than others to suffer from stroke. Asian American women have the highest incidence of cervical cancer and a mortality rate four times >the overall population. The asthma rate for African American and American Indian adults in Hennepin County is more than 25% > whites.

22 Minnesota Community Measurement Health Care Disparities Report 2009 For eight of the ten measures at the statewide level, health care best practices were achieved significantly less often for patients enrolled in MHCP than for patients enrolled with Other Purchasers.

23 Health Care Disparities Are a Quality Issue Disparities measure gaps in quality of health care. Quality improvement tools and techniques have been shown to improve health care disparities. To understand gaps in quality by population, it is important to have data. Race, ethnicity, and language data define quality for distinct areas of the population.

24 Differences in Subpopulations Magnitude and patterns of disparities vary among subpopulations. The complete picture of disparities is different for each population.

25 How Do We Accurately Measure Health Disparities in Minnesota to Further the Work of Elimination of Disparities?

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27 Data collection helps define disparities and their improvement. What disparities exist, and in which populations? Are interventions effective at reducing or eliminating disparities over time?

28 For Clinics: Outcome data Identifying differences in outcomes and developing interventions aimed at specific populations Appropriate treatment of emerging populations Programs for patient populations with disparities Anticipating outcomes based on populations served. Cost data Understanding needs for interpreter services and costs Identifying trends in patient populations, and identifying resources necessary to serve them:

29 Ok, we know why, but the many reasons not to still exist.

30 Barriers to Collecting Data Concerns about 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

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32 Framework for Data Collection

33 What to collect How to collect it Who should collect it Where is it stored What do you do with it

34 To effectively compare results and analyze the data across medical groups in Minnesota and border counties, a standard set of data elements was needed. In the EAWG, no two medical groups were using the same set of data elements, so defining a common set of data elements became the first task. Minnesota Community Measurement Handbook

35 Electronic vs paper HIM dept involvement Work team creation

36 Schedulers? Front desk at check-in? MA/MD team?

37 If on your computer, how do you roll it up?

38 What do you do with it? How does it fit into quality measures?

39 Critical Success Factors Complete a project definition and get organizational buy-in before you begin. Engage teams and leaders at the earliest possible stage to gain buy-in and obtain input. Have appropriate and visible support from a senior leader. Be clear about and frequently communicate the reasons for the project. Develop and deliver clear, concise training and learning support Identify measures of success and publicize achievements. Establish methods for continuous process management.

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41 Plan for initial staff training, on-going as necessary Training goals: To implement an efficient, valid, and reliable method of collecting information that is acceptable to patients and staff To provide staff with information and tools they can use Anticipate and overcome staff discomfort with asking for information

42 Staff Training To Provide the Following Toolkit Scripts Categories How to address concerns from patients

43 Patients Are Comfortable Providing Information When they are given a reason why it is being collected

44 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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