Ethnic Backgrounds At Hospital ForeFrontBy Susan Bush
12:00AM / Friday, December 15, 2006
Here's hoping most folks know their ethnic ancestry.
New Race And Ethnicity Reporting Regulations
Beginning in January, state-based hospitals will begin a detailed patient reporting initiative that examines racial and ethnic backgrounds of the population being served.
The enhanced documentation is the result of new regulations issued by the Massachusetts Division of Health Care Finance and Policy and the Boston Public Health Commission.
The new process is set to begin on Jan. 1 and an initial state reporting deadline of April 1 is in place, according to information available at a Massachusetts Hospital Association Internet web site.
Judy Parlato, clinical advisor for the Massachusetts Division of Health Care Finance and Policy, said during a Dec. 14 interview that individual identities will not be included in the data collection process.
State Says Improve Research, Reduce Disparities
But information about race and ethnicity will be gathered and provided to a federal agency, the Agency of Healthcare, Research, and Quality, Parlato said. That agency is examining disparities in the healthcare services delivery system.
"There are other states doing this and we are one of the first to be doing it," Parlato said. "People want to improve the research and reduce disparities in healthcare."
The information will not be used for immigration determinations, according to MHA information. There are no legal or other consequences to a hospital or a patient if a patient refuses to disclose ethnic information.
Parlato said that under the new patient information collection system, documentation of a person's race and ethnic background, symptom presentation, diagnosis and the specific treatment delivered will be included.
"We are collecting this discharge data from all acute care hospitals in the state," she said.
Officials at the North Adams Regional Hospital have scheduled a Dec. 18 media conference to discuss how the information collection will impact patients and staff at the hospital. One reason for the conference is so that the public can be alerted to the new procedure, said hospital Community Relations Director Paul Hopkins.
Parlato emphasized that the data is not a part of the state's health care reform initiative nor is it a terrorist profiling tool.
Thirty-Three Ethnic Categories, "To Begin With"
She acknowledged that there may be some discomfort among patients being asked to disclose the information. Under the collection protocol, instead of relying solely racial identifiers such as "white," "Asian," "African-American" or "Hispanic," people may be asked to offer additional details.
For instance, an individual identified as being from Central America could be asked if they are from Nicaragua, Panama, or another nation. Someone identified as being African could be asked to identify whether they are Ethiopian or Liberian. A person who discloses that they are "European" could be asked if they are of French, German, Swiss, or other lineage.
"We are working with 33 categories of ethnicity to begin with," Parlato said.
Training sessions are underway for those who will collect the data, she said.
"People don't always know the best way to ask this," Parlato said."The training that we've had with the Massachusetts Hospital Association has shown that there are ways to ask these questions."
One mechanism for collecting the information involves self-reporting or people could be verbally asked about their ethnicity.
All information collected, including the diagnosis and treatment information, will be used to pinpoint any disparities in healthcare and also to detect health trends in specific populations, Parlato said.
Health Care Disparities Among Many Groups, Says Report
"This is used for research," she said. "When we do research, we look for disparities. The detailed breakdown of this information will provide a detailed analysis. This will help improve program planning, treatments, and protocols and help identify incidence of [health] conditions."
According to a 2003 AHRQ report, "Health care consumers who are members of certain groups, termed 'disparity populations,' frequently confront disparities in health care quality relative to the general population. members of these disparity populations include racial and ethnic minorities, low-income persons, children, women, the elderly, rural and urban residents, persons with disabilities and chronic illness, and persons near the end of life."
The report further states "Low-income persons often become chronically ill or die at earlier ages than those with higher incomes. Poorer persons experience many access barriers to quality health care such as affordability of acre and low health care literacy. Inner-city and rural residents often reside in medically under-served areas and often face geographic and other barriers to care."
Data collection rooted in race and ethnicity is warranted, the report states. Births, breast cancer, mental illness/depression hospital management of congestive heart failure, pneumonia and additional conditions were cited in the report as examples of disparity in treatment and outcome.
"Significant disparities in treatment of these conditions have been found for racial and ethnic minorities, low income persons, and in some instances, women," the report states. "Stratification of these measures by race and ethnicity and SES [socioeconomic status] is warranted. Theses measures should be reported separately by race, ethnicity and income. They should also be reported by gender for selected cardiovascular treatments."
From The MHA
Public information issued by the MHA states that "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."
The MHA information states that because language barriers can contribute to medical treatment and information gathering challenges, "we are also collecting information related to the patient's primary spoken language."
The most effective mechanism for reducing health care disparity, detecting ethnic links to specific health conditions and improving treatments and outcomes for all people means detailed examination of patient specifics, Parlato said.
"If you don't take a look at things such as race and ethnicity, you can't identify the problem," she said.
Susan Bush may be reached via e-mail at firstname.lastname@example.org or at 413-663-3384 ext. 29