Cambridge Health Alliance Collecting Race, Ethnicity and Language from Patients

Enclosed you will find resources created by the Cambridge Health Alliance to implement a system for the Collection of Patient Self-Identified Race, Ethnicity and Language. Materials were developed based on recommendations from state regulations promulgated by the Division of Health Care Finance an Policy, the Health Education and Research Trust (HRET) Disparities Toolkit and with the support of a statewide working group with numerous partners including the Massachusetts Hospital Association, the Disparities Solution Center, the Massachusetts Department of Public Health and the Boston Public Health Commission. All resources developed by the Cambridge Health Alliance are currently being used within the Alliance for training and implementation and have also been made available to all other hospital and healthcare systems in the Commonwealth of Massachusetts.

Table of Contents Rationale for Data Collection Patient Education Flyer Patient Frequently Asked Questions Data Collection Instrument Race Identification Card Staff Training Slides Guide for Primary Data Collectors Role Play Exercise for Staff Training Provider Frequently Asked Questions Posting for Internal Communications

Rationale for Race and Ethnicity Data Collection Provided to Patients At the Cambridge Health Alliance, we provide the best care possible for all of our patients. We are now collecting race and ethnicity information from all of our patients to help us know them better. We can learn more about the communities we serve if we know your race and ethnicity. We can better care for all patients if we know more about race, ethnicity, language and culture. This information will only be used to give all patients the best care possible.

MITT ROMNEY GOVERNOR KERRY HEALEY LIEUTENANT GOVERNOR The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street Boston, Massachusetts 02108-4619 TIMOTHY R. MURPHY SECRETARY PAUL J. COTE, JR. COMMISSIONER MDPH Race-Ethnicity and Language Preference Instrument, December 2006 Introduction: In order to guarantee that all patients receive the highest quality of care and to ensure the best services possible, we are asking all patients about their race, ethnicity, and language. 1. Are you Hispanic/Latino/Spanish? Yes No 2. What is your ethnicity? (You can specify one or more) African (specify ) African American American Asian Indian Brazilian Cambodian Cape Verdean Caribbean Islander (specify ) Chinese Colombian Cuban Dominican European (specify ) Filipino Guatemalan Haitian Honduran Japanese Korean Laotian Mexican, Mexican American, Chicano Middle Eastern (specify ) Portuguese Puerto Rican Russian Salvadoran Vietnamese Other (specify ) Unknown/not specified 3. What is your race? (You can specify one or more) American Indian/Alaska Native (specify tribal nation ) Asian Black Native Hawaiian or other Pacific Islander (specify ) White Other (specify ) Unknown/not specified

4. In what language do you prefer to discuss health-related concerns? English Spanish Portuguese Cape Verdean Creole Haitian Creole Khmer Vietnamese Somali Arabic Albanian Chinese (specify dialect ) Russian Other (specify ) 5. In what language do you prefer to read health-related materials?

MDPH Detailed Ethnicity Categories and Supplemental Code Set December 4, 2006 ETHNICITY CATEGORIES Cuban 2182-4 Dominican 2184-0 Mexican, Mexican American, Chicano 2148-5 Subcategories and Supplemental Code Set Mexican American 2149-3 Mexicano 2150-1 Chicano 2151 9 La Raza 2152-7 Mexican American Indian 2153-5 Puerto Rican 2180-8 Salvadoran 2161-8 Central American (Other) 2155-0 Costa Rican 2156-8 Nicaraguan 2159-2 Panamanian 2160-0 Central American Indian 2162-6 Belize South American (Other) 2165-9 Argentinean 2166-7 Bolivian 2167-5 Chilean 2168-3 Ecuadorian 2170-9 Paraguayan 2171-7 Peruvian 2172-5 Uruguayan 2173-3 Venezuelan 2174-1 South American Indian 2175-8 Criollo 2176-6 Guyana African 2060-2 Botswanan 2061-0 Ethiopian 2062-8 Liberia 2063-6 Namibian 2064-4 Nigerian 2065-1 Zairean 2066-9 African also includes: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Congo, Cote d Ivoire, Djibouti, Egypt, Equatorial Guinea, Eritrea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Libya, Madagascar, Malawi, Mali, Mauritania, Mauritius, Morocco, Mozambique, Niger, Reunion, Rwanda, Sao Tome & Principe, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tanzania, Togo, Tunisia, Uganda, Western Sahara, Zambia, and Zimbabwe African American 2058-6 American AMERCN Asian 2028-9 Bangladeshi 2030-5 Bhutanese 2031-3 Burmese 2032-1 Hmong 2037-0 Iwo Jiman 2048-7 Indonesian 2038-8 Madagascar 2052-9 Malaysian 2042-0 Maldivian 2049-5

Nepalese 2050-3 Okinawan 2043-8 Pakistani 2044-6 Singaporean 2051-1 Sri Lankan 2045-3 Taiwanese 2035-4 Thai 2046-1 Asian Indian 2029-7 Brazilian BRAZIL Cambodian 2033-9 Cape Verdean CVERDN Caribbean Island CARIB Barbadian 2068-5 Dominica Islander 2070-1 Jamaican 2072-7 Trinidadian 2074-3 Tobagoan 2073-5 West Indian 2075-0 Chinese 2034-7 Columbian 2169-1 European 2108-9 Filipino 2036-2 Guatemalan 2157-6 Haitian 2071-9 Honduran 2158-4 Japanese 2039-6 Korean 2040-4 Laotian 2041-2 Middle Eastern or North African 2118-8 Portuguese PORTUG Russian RUSSIA Vietnamese 2047-9 Other OTHER Unknown/not specified UNKNOW English 2110-5, French 2111-3, German 2112-1, Irish 2113-9, Italian 2114-7, Scottish 2116-2, Greek GRK, Spanish SPAN, Armenian 2109-7, Polish 2115-4 Albanian ALBA, Azerbijan AZER, Belarus BELA, Bosnia and Herzegovina BOSHER, Bulgaria BULG, Croatia CRO, Czech Republic CZECH, Estonia EST, Georgia GEOR, Hungary HUNG, Latvia LAT, Lithuania LITH, Moldova MOLD, Macedonia MACD, Montenegro MONT, Romania ROM, Serbia SERB, Slovakia SLOVK, Slovenia SLOVE, and Ukraine UKR Assyian 2119-6 Egyptian 2120-4 Iranian 2121-2 Iraqi 2122-0 Lebanese 2123-8 Palestinian 2124-6 Syrian 2125-3 Afghanistani 2126-1 Israeli 2127-9 Middle Eastern also includes: Algerian, Jordan, Kuwait, Oman, Qatar, Saudi Arabia, Sudanese, United Arab Emirates, and Yemen Azorean Canarian 2145-1

Help Us Know Our Patients Better When we know your race and ethnicity, we learn more about your culture and language. This helps us to know you better and to improve the care that we give to all patients. Beginning in January 2007, we will ask for race and ethnicity information from all patients. We can better meet the needs of the communities that we serve if we know more about our patients race, ethnicity, culture and language. What is your RACE? You can choose more than one. American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian Black White Other Help Us Know Our Patients Better When we know your race and ethnicity, we learn more about your culture and language. This helps us to know you better and to improve the care that we give to all patients. Beginning in January 2007, we will ask for race and ethnicity information from all patients. We can better meet the needs of the communities that we serve if we know more about our patients race, ethnicity, culture and language. What is your RACE? You can choose more than one. American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian Black White Other Help Us Know Our Patients Better When we know your race and ethnicity, we learn more about your culture and language. This helps us to know you better and to improve the care that we give to all patients. Beginning in January 2007, we will ask for race and ethnicity information from all patients. We can better meet the needs of the communities that we serve if we know more about our patients race, ethnicity, culture and language. What is your RACE? You can choose more than one. American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian Black White Other Help Us Know Our Patients Better When we know your race and ethnicity, we learn more about your culture and language. This helps us to know you better and to improve the care that we give to all patients. Beginning in January 2007, we will ask for race and ethnicity information from all patients. We can better meet the needs of the communities that we serve if we know more about our patients race, ethnicity, culture and language. What is your RACE? You can choose more than one. American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian Black White Other

Changes to Meditech Registration

Reporting Race and Ethnicity A Guide for Data Collection

Before we begin Only have to collect it once, if we collect it correctly.

Agenda What are health disparities? Why are data important? How will we collect the data? How should we address concerns? Role Plays Resources and Questions

What are health disparities? Health disparities are differences between populations in: Presence of disease Access to health care Use of health care services Health outcomes

What causes health disparities? Social, economic, and environmental factors Barriers to getting health care Differences in quality of health care

Top Disparity for Blacks New Cases of AIDS 12 10.4 10 8 6 White Black 4 2 1.0 0 Odds Ratio of New Cases of AIDS for Blacks= 10.4 2005 National Healthcare Disparities Report

Top Disparity for Asians Lack Mental Health Treatment for a Serious Illness 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 1.0 1.6 White Asian Odds Ratio of Lack of Treatment for Asians= 1.6 2005 National Healthcare Disparities Report

Top Disparity for Hispanics 4 3.5 3 2.5 2 1.5 1 0.5 0 New Cases of AIDS 1.0 3.7 White Hispanics Odds Ratio of New Cases of AIDS for Hispanics= 3.7 2005 National Healthcare Disparities Report

To Eliminate Disparities, We Need to Collect Better Data

Why Improve the Data? Asian 77% Hispanic 71% State 70% White, Non-Hispanic 70% Black, Non-Hispanic 68% 0% 20% 40% 60% 80% 100% Percent of Mothers Breastfeeding by Race/Ethnicity, MA

Source: Asian Births in Massachusetts: 1996-1999; Hispanic Births in Massachusetts: 1996-1999; and Black Births in Massachusetts: 1997-2000 Asian Indian 91% Japanese Pakistani Korean Filipino Thai MA TOTAL 71% Chinese Vietnamese Laotian Cambodian 35% Percent of Asian Mothers Breastfeeding by Ethnicity, MA 0% 20% 40% 60% 80% 100%

Why Collect the Data? Identify Disparities Target Interventions Improve Quality

What do Patients Think?

It is important for hospitals and clinics to collect information from patients about their race or ethnic background Strongly agree 43% Somewhat agree 37% Unsure 6% Somewhat disagree 10% Strongly disagree 4% Study conducted at Northwestern Memorial Hospital Data shown in HRET tool kit

It is important for hospitals and clinics to conduct studies to make sure that all patients get the same highquality care regardless of their race or ethnic background Strongly agree 93% Somewhat agree 4% Unsure 2% Somewhat disagree 1% Strongly disagree 0% Study conducted at Northwestern Memorial Hospital Data shown in HRET tool kit

How concerned would you be that this data could be used to discriminate against patients Not concerned at all 34% A little concerned 15% Somewhat concerned 20% Very concerned 31% Study conducted at Northwestern Memorial Hospital Data shown in HRET tool kit

How can we do this? Introduce the Questions Use Tools for Registration Staff Distribute Patient Education Materials

Tools for Registration Reporting Race, Ethnicity and Language: A Guide to Helping Patients

Introduction The Introduction should tell patients: We are collecting race and ethnicity data from all patients We need this information to know more about your culture and language This will only be used to better meet the needs of the patients we serve

Introduction At the Cambridge Health Alliance, we provide the best care possible for all of our patients. We are now collecting race and ethnicity information from all of our patients to help us know them better. We can learn more about the communities we serve if we know your race and ethnicity. We can better care for all patients if we know more about race, ethnicity, language and culture. This information will only be used to give all patients the best care possible.

Race and Ethnicity

Race and Ethnicity: What s the Difference?

What will change?

What is your race?

If a patient asks What is Race? Your race is the group or groups that you identify with as having similar physical characteristics or similar social and geographic origins. You can tell me more than one. For example, please let us know if you are Asian, Black, White, etc. Record Patient s Response

What is your RACE? You can tell us more than one. American Indian or Alaska Native Asian Black Native Hawaiian or other Pacific Islander White Other

What is your ethnicity?

If a patient asks What is Ethnicity? Your ethnicity refers to your background, heritage, culture, ancestry or sometimes the country where you were born. You can tell me more than one. For example, please let us know if you are Haitian, Vietnamese, Brazilian, etc. Record Patient s Response

Are you Hispanic, Latino or Spanish?

If a patient asks What is meant by Hispanic, Latino or Spanish? A person is Hispanic, Latino or Spanish if they or their family come from a country in Latin America or another Spanishspeaking country. Record Patient s Yes or No Response If the response is some, partly, half, or a little, please enter Yes. If a patient declines, enter No.

Any other races?

Only have to collect it once, if we collect it correctly.

What your country of residence? If OUTSIDE of the US

Asking about Language What is the primary language spoken in your home? Language Spoken In what language do you prefer to read health-related materials? Written In what language do you prefer to discuss health-related concerns? Medical Care

Asking about Language REMEMBER You can use Phone Interpretation. Dial 3333 and press 2 for phone

Addressing Patient Concerns

Transfer Hospital If the Admissions Source on the B/AR Info tab is Transfer from other facility, (HOS or HOS-CHA) then an additional field must be filled out on the Other tab.

Role Plays

Questions for Role Plays -What is your Race? - What is your Ethnicity? - Are you Hispanic, Latino or Spanish? - Any other races?

Resources

Questions

Contact: Jacquelyn Caglia Community Affairs 617.499.6618 jcaglia@challiance.org

These slides were adapted by the Cambridge Health Alliance using original materials from : MGH Disparities Solution Center MA Department of Public Health

Tools for Registration Reporting Race, Ethnicity and Language: A Guide to Helping Patients

STOP Before you continue PLEASE remember that it is very important to ask ALL patients. No Assumptions!

Introduction Several studies have shown that a brief introduction before asking the questions makes patients more comfortable. This will make your job easier and will make the data we collect better!

Introduction At the Cambridge Health Alliance, we provide the best care possible for all of our patients. We are now collecting race and ethnicity information from all of our patients to help us know them better. We can learn more about the communities we serve if we know your race and ethnicity. We can provide better care for all patients if we know more about race, ethnicity, language and culture. This information will only be used to give all patients the best care.

If a patient asks Why? We are collecting this information from all patients. This will help us to see differences in health among different populations. We can reduce those differences by making sure that all patients receive the same quality of care.

If a patient asks Why? There are new state regulations requiring that all hospitals in Massachusetts to collect this information. This information will only be used within the Cambridge Health Alliance to improve the care that our patients receive.

If a patient asks about Privacy Your privacy is protected. We will not share this information with Immigration

If the patient responds I m Multiethnic We can record as many categories as you need to describe yourself. Please tell me all of your ethnicities. Record Patient s Response

If the patient cannot describe their ethnicity Give examples! For ethnicity, please let us know if you are Haitian, Vietnamese, Brazilian, etc. You can tell me in your own words and I will record your response. Record Patient s Response If category not found, use Free Text!

If the patient responds I m Multiracial We can record as many categories as you need to describe yourself. Please tell me all of your races. Record Patient s Response

If the patient cannot describe their race Give examples! For race, please let us know if you are Asian, Black, White, etc. You can tell me in your own words and I will record your response. Record Patient s Response If category not found, use Free Text!

Asking about Language What is the primary language spoken in your home? In what language do you prefer to read health-related materials? In what language do you prefer to receive your medical care?

Asking about Language Have you requested an interpreter if one is needed? REMEMBER You can use Phone Interpretation. Dial 3333 and press 2 for phone

If the patient thinks the answers are obvious I understand that you may think that the answers are obvious. I have to ask every patient. It is really important that we record your response. Record Patient s Response

If the patient refuses I understand that these questions may be a little sensitive. We are required to ask all patients. This information will be kept private and will only be used to improve the healthcare we provide to all. Record Patient s Response

If the patient still refuses That is okay. You have the right to not answer these questions. Record Patient s Response as Declined

If the patient gets upset Please stay calm. I will call my manager.

If the patient wants more information Here is a pamphlet explaining more about why we are collecting this information and how it can be used to better meet the needs of communities that we serve.

THANK YOU! Your help with collecting this information is really important. Thank you for all that you do for the Cambridge Health Alliance and our patients. Obrigada Merci Gracias Mesi

This tool, Reporting Race, Ethnicity and Language: A Guide to Helping Patients was developed in collaboration with: MA Department of Public Health Boston Public Health Commission MGH Disparities Solution Center MA Hospital Association Cambridge Health Alliance

Training Role Plays Trainer: As part of a training for registration staff on how to ask patients about their race, ethnicity, and language, you explain how to ask patients for information about their race. Explain how you would like the staff member to ask the question, and respond to his/her concerns. Objective: To help registration staff understand how to address patient concerns when being asked about race and ethnicity. Registration staff: You are being trained to collect race, ethnicity, and language data from patients. Before this job, you worked at a hospital that asked this information, and you found that some patients were offended by the request, so you re worried about asking for this information. Example: I don t think we should be asking for that patients will be upset. Trainer: You are training registration staff on how to ask patients for information about their race, ethnicity, and language. This is the third training you ve run for your staff, and you keep having to explain why it s important to collect these data. Objective: Explain the importance of collecting these data to staff, and how long you expect this to add to the registration process. Registration staff: You are being trained to collect race, ethnicity, and language information from patients. When you re told about this new requirement, you re frustrated that you already have too much information to get from patients, and don t think this is important. Example: We can barely collect all the information we have to. I don t see why this is so important, and it will just take longer. Trainer: When training registration staff about how to collect information from patients, you explain the difference between race and ethnicity and why they re asked about separately. Objective: Clarify the difference between race and ethnicity, and reinforce the need to ask both questions. Registration staff: You are being trained to collect race, ethnicity, and language data from patients. Your trainer has told you about the difference between race and ethnicity, but you still don t understand why there are two question and don t think it s important for you to ask both of them.

Data Collection Role Plays Registration: It is 4:30 on a Friday afternoon. The clinic is very busy today and you have registered a lot of patients. It has been a long week and you are feeling pretty tired. You are hoping that not many people come in during your last half hour. Objective: How do you answer questions in a way that calms patient fears about immigration status? Patient: You recently came to the US from Guatemala and you are going to the clinic for the first time in this country. You don t have health insurance, but you have heard that people without it can still get care at this clinic. You have had a bad cough for many weeks and are afraid that you are very ill. Your English is still not very good, so you brought along your niece. You are worried that people will think that you don t have your papers and hope that your niece can help you communicate. Registration: You are feeling good today. Things have been going well at work and everything at home is great. Your friend just stopped by the clinic to say hello and it put you in an even better mood. This morning, your boss told you that you are doing a great job with the patients. Objective: How do you ask questions when patient s first language is not one that you speak? Patient: You have traveled from Iran to visit your family in Cambridge. Your daughter is a professor at Harvard. You like coming to America to see how she is living. Unfortunately, you fell down the stairs this morning. Your daughter took you to the doctor on her way to a big conference that she couldn t miss. You know some English, but she told you that there were people who speak Farsi here at the hospital who will help you.

Registration: Today has been an okay day. You are a little stressed because the clinic had a JCAHO evaluation yesterday. You weren t working yesterday, but your boss says that staff in the clinic has to do a better job at working with patients. You aren t really sure what this means, but you are trying to be more helpful today. Objective: How do you address patient questions about what ethnicity means and assist them to identify theirs? Patient: You notice a sign posted in the clinic while you are waiting in line to register. It says that the Cambridge Health Alliance is going to be collecting race and ethnicity information from all patients. You aren t sure what this means and you are worried that you won t know how to answer the questions. Registration: It is hard for you to ask the new questions about race and ethnicity during registration. You aren t really sure why the hospital needs this information anyway and it really slows down your process. Objective: How do you assist a patient with self-identification of all of their races and ethnicities? Patient: It has been all over the news about how hospitals need to ask all patients for their race and ethnicity. You really dislike these questions because they force you to pick a category. You almost always say Other because you are Black and White and Hispanic. Sometimes you say that you are Multiracial but most of the time they try to make you pick and you really don t think that describes who you are. Registration: You just finished a very long registration process with a patient that was asking a lot of questions. Normally, you take the time to answer them and have a lot of patience, but your line is three people long! You are really hoping that the next guy is easy so that you can get rid of the line. Objective: How do you handle a situation when a patient gets upset and doesn t want to answer the questions? Patient: You are surprised to hear that the person in front of you in line at the clinic has to tell the registration staff what their race and ethnicity are. You wonder if this information is being collected for the government or to discriminate against minorities. You know that you have the right to not answer these questions and you aren t going to tell anybody about your heritage. What does it matter to your health anyway?

Registration: It has been a busy day in the emergency room. You have had a line since you started and it is only 12 o clock. You see a woman that you know because she comes in a lot is next in line. You wonder how she is going to respond to the new questions you have to ask about her race and ethnicity, especially since you know her pretty well. Objective: How do you handle a situation when you are very familiar with a patient? Patient: You are going to the emergency room for a sore throat. You come in pretty often for yourself and family members and you know the registration staff pretty well. You had to wait almost a half hour to register, but you are happy to see your friend working behind the desk. Registration: It is 4:00 am and you are having a rough and busy shift. You didn t get much sleep because your children are sick and stayed home from school. You are irritable, tired, hungry, and worried about your kids. You have been asking the race and ethnicity questions for a few weeks now and you realize that you can almost always guess the patient s answers before they say it. Your manager isn t around and more and more patients are coming into the emergency room. Objective: How do you record this information from all patients in a standardized way? Patient: You were working the night shift at Shaw's and cut your hand very deeply on the deli slicer. You have heard from family members about the new questions that they are asking at the hospital. Your family members told you that it was uncomfortable and frightening. You had a discussion together about your family s heritage and you now know that you are Brazilian, Black, and Hispanic. You will be able to answer the hospital s questions confidently.

Registration: Patient Pat Willis has come to register before seeing her doctor. You must collect race, ethnicity, and language information from Ms. Willis, who is offended when asked about her race. Objective: To address the patient s concerns about being asked about race and ethnicity. Patient: You are patient Pat Willis and were told to go to patient registration before seeing your doctor. You are offended when asked about your race and ethnicity. You do not immediately provide the information, but instead express your feelings to the staff person who requested the information. Example: That s none of your business. Registration: Patient Chris Costillo must register before being admitted for a biopsy. You must collect race and ethnicity information from Mr. Costillo, who is concerned about his privacy. Objective: To address the patient s concerns about the privacy of his information. Patient: You are patient Chris Costillo and were told to go to patient registration before being admitted for a biopsy. When asked about your ethnicity, you do not immediately provide the information because you are worried about who will see it and how it will be used. Example: What is going to happen to the information if I give it to you?

Race & Ethnicity Data Collection: Frequently Asked Questions for Providers Recently the Massachusetts Division of Health Care Finance and Policy (the Division) and the Boston Public Health Commission (BPHC) issued regulations that require all acute care hospitals to collect and report on detailed race and ethnicity demographic information, among other items [State regulations 114.1 CMR 17.00 regulation, adopted July 2006, BPHC Data Collection Regulations adopted June 13, 2006]. Hospitals must begin collecting the new data on January 1, 2007, and report the data (corresponding to January 1 through March 31, 2007) to the state beginning in April 2007. This one-page document attempts to answer questions that hospital staff may have related to the new requirements. Q: Why are we increasing our efforts to track race and ethnicity? A: Putting state and local mandates aside, all hospitals are committed to providing high-quality, timely access to patient care by developing innovative strategies to enhance quality, reduce cost, and increase efficiency. Research shows that some racial and ethnic groups often experience worse health outcomes than others. Many factors, such as poor housing, lack of consistent health care, and poverty may contribute to this problem. Massachusetts is collecting information to identify population differences in care and outcome within our hospitals, and to improve the quality of care by initiating programs, such as interpreter services and cultural competency training for staff, as well as translating patient information materials into different languages. For these reasons we are also collecting information related to the patient s primary spoken language. Q: Who came up with the new methods for complying with the state regulations? A: A group of hospitals, state agencies, community advocates, and others have been meeting to develop operational tools to help hospital staff with collection of these new data requirements and ensure that the data collection process is consistent and uniform. A patient flyer, patient FAQs, a script on how to ask questions and more are all the result of this workgroup. In addition, the Disparities Solutions Center, funded in part by the Boston Public Health Commission, has developed a training guide to assist hospitals in understanding how to collect data in a uniform and consistent manner. Providing these materials will ensure that the statewide reporting provides results that are easily comparable on a statewide or regional basis. Q: My hospital already tracks this data. Why reinvent the wheel? A: Many hospitals already recognize the disparities in health care delivery and are taking steps to reduce them. However, collecting race and ethnicity data is not easy. Hospitals are collecting various types of information and asking patients different questions. Many hospitals collect race but not ethnicity, or they collect primary language or just spoken language data. Some hospitals collect data just through observation. Standardizing the collection process with patient self-reporting of their race and ethnicity will improve the accuracy of the data available to understand and address health disparities and inequalities in health care delivery. This unified program allows us to collect data efficiently, effectively, and respectfully. Q: How will the data from my hospital be used by the state? A: The data collected by the state will be used to target programs and services to those in need, to develop health care policy, and to assist with public health studies. The information will not be used in immigration determinations. The goal is to collect and release de-identified health information to assist providers, health care payers, and government agencies focus on reducing disparities in health care. This information will help determine illnesses that are more prevalent in some ethnicities and to improve treatment protocols for them. All related to assisting hospitals improve and tailor health care programs provided to their patients. Q: I feel uncomfortable about asking patients about their race & ethnicity? A: Recent surveys conducted in Massachusetts and elsewhere in the country show that a large majority of patients strongly agree or somewhat agree that it is important for hospitals and clinics to collect information from patients about their race or ethnic backgrounds. Patients are more concerned about how the data will be used and, as stated above, it will not be shared with groups outside the hospital.

Health Disparities Improved Race, Ethnicity, and Language Data Collection Description: In 2002, the Institute of Medicine released a report that revealed striking disparities of health care services delivered to minority and white patients, and urged the development of interventions and educational efforts. Health disparities are population-specific differences in access to care, presence of disease, and health outcomes. The potential causes of these differences are complex and need to be better understood in order to address them. Cambridge Health Alliance is well-positioned to be a leader in the area of identifying and reducing, or eliminating, racial and ethnic disparities in health care. Our patient population is extremely diverse and many of our programs have been designed by knowing our patients' needs and providing excellent, culturally competent services. We at CHA understand that addressing disparities is a quality improvement issue, consistent with good medical practice. We at CHA also have the will to improve and innovate, and the staff, structure and tools, including information technology, to make change happen. The foundation for efforts to address disparities is the collection of good data. To help us better understand differences among patients in our system, we will be starting an improved system of collecting patient race and ethnicity information during registration. Phase I of this plan, to be implemented in inpatient, ED and outpatient observation, will begin on December 1, 2006. Implementation for the rest of the Alliance system will begin soon after the New Year. Staff and providers are receiving tools and training in order to respond to any patient concerns and to collect this important information in a respectful way. The implementation timeline is consistent with new regulations issued by the MA Division of Health Care Finance and Policy and the Boston Public Health Commission which require all acute care hospitals to collect and report on detailed race and ethnic demographic information. While we are mandated to begin collecting the new data on January 1, 2007 (and report to the state starting April 2007) CHA's commitment is not driven by this requirement. We are committed to providing high quality care to all our patients, and to improving the health of all in our communities. -CEO Message from EBeat- Key to the success of this effort are good communication, keeping everyone informed and using the resources that have been developed. Educational Flyers Describes the changes taking place, details the new questions that will be asked of patients and provides examples of how to answer the new questions. -to be posted around the Alliance at all sites of registration CHA Distribution (English) (Spanish) (Portuguese) (Haitian Creole) Patient Frequently Asked Questions Pamphlet A handout for patients providing them with information to frequently asked questions such as Why is this information being collected? and How are my race and ethnicity related to my health? -to be distributed to patients if questions arise CHA Distribution (English) (Spanish) (Portuguese) (Haitian Creole) Race Identification Card A tool to assist patients with the identification of their race or races. -to be available in each registration area (English) (Spanish) (Portuguese) (Haitian Creole)

A Guide for Registration Staff A tool for registration staff with scripts for how to respond to common questions and concerns. -booklet available in each registration area Provider Frequently Asked Questions A document from the Massachusetts Hospital Association with more detail for providers and staff. -please distribute to staff as needed Training Resources Slides for staff training and role plays for practice with the new questions -to be used in training staff PowerPoint Presentation of Training Role Play Exercise IT Educational Materials on Staff.Net Ambulatory Inpatient, Outpatient Observation, ED and SDC Additional Race and Ethnicity Resources Regulatory Changes from the Division of Health Care Finance and Policy Massachusetts Hospital Association Resources For more information, please contact Jacquelyn Caglia at jcaglia@challiance.org