Uniformly collect data on patients' race, ethnicity and primary language in order to track and address disparities in quality of care.
Why It's Important:
Leaders of U.S. hospitals say they provide the same level of care regardless of a patient's race, ethnicity or language, but few, if any, really know for certain. That's because most of America's hospitals do not have a uniform system for tracking the race, ethnicity and language preferences of their patients. Those that do collect data often “eyeball” patients to make those determinations, rather than asking patients directly, and hardly any hospitals use these data to gauge how their care of minority patients stacks up against known quality standards.
How To Do It:
Uniformly tracking information on patients' race, ethnicity and language preferences provides hospitals with powerful tools for ensuring that consistent care is provided to every patient.
Hospitals that participated in Expecting Success reported monthly data on 20 cardiac care quality indicators, all analyzed by patient race, ethnicity and language. Their advice to others:
1. Gather opinions from top to bottom.
It's important to discuss the purpose and process for collecting patient data by race, ethnicity and preferred language with everyone—the CEO, quality department, information technology (IT), legal, registration, physicians, nurses and other front-line staff. Everyone will ultimately help derive meaning from the data analysis to create interventions to improve care based on the information, so it is vital to get widespread buy-in and support.
Tip: Some hospital staff think it's illegal to collect these data, but sharing published research from a variety of sources helps affirms its legality for improving quality. (See Tools to Help.)
2. Reject preconceived ideas about who your patients are.
Most Expecting Success hospitals thought they knew who their patients were, but the resulting race/ethnicity/language data challenged their assumptions. Some learned that more patients want to communicate in another language than they realized. Many are now re-thinking their language services programs and making sure materials are culturally appropriate.
3. Use consistent categories for data collection.
The current race and ethnicity categories used by the Office of Management and Budget are the recommended standard, yet given the United States' increasingly diverse population, the Expecting Success program used an expanded list of categories. (See Tools to Help).
4. Gather the data directly from patients at registration.
All Expecting Success sites determined a time, place and person responsible for gathering the data, usually at registration, but sites relied on patients or their caregiver to provide the information directly, rather than registration staff “eyeballing” patients and making assumptions.
5. Think through the technology issues.
IT staff must ensure the data transfer to all relevant patient databases—including programs that track the specific care received. Most of the Expecting Success hospitals use Microsoft Access databases, so altering the database to track patient race/ethnicity/language was not technologically difficult.
Tip: Because adding fields on a hospital's electronic registration system is real estate that's tough to secure, the hospitals say that having the CEO vocally support the new procedures helped cut through hospital politics with IT.
6. Registration managers hold keys to success.
Expecting Success hospital staff say that registration staff managers were paramount to making sure the new procedures worked. They extensively trained the managers on the data collection process so they could in turn train their staff. At one hospital, where more than 600 registrars are spread out over 90 locations, this training required a logistical tour de force, but is largely credited as a main reason the adoption ran smoothly.
7. Set the script.
Having a consistent script helped the registrars ask the data collection questions in a manner that was clear and inoffensive. While registration staff wanted the script, they also wanted latitude in how they approached the task. (See Tools to Help).
8. Provide detailed staff training.
Sites provided their staff with sample scripts, role-playing and trouble-shooting scenarios to make registration staff comfortable.
9. Check progress.
After data collection began, all sites monitored progress. Some analyzed data by registration staff to see which staff had a high number of empty fields or ‘unspecified' answers, which helped them counsel staff accordingly. Others noticed that staff on certain shifts was not consistently asking the questions and needed more training.
10. Don't worry.
Expecting Success program leaders say participating hospitals had a lot of anxiety about the data collection process, worrying that it would alienate patients or take too long. None of their fears materialized.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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