RWJF project tracks data to check equality of care

Most facilities don't have uniform system

The question of whether America's hospitals provide the same level of care regardless of a patient's race, ethnicity or language is being addressed in an initiative by the Robert Wood Johnson Foundation.

Ten hospitals are taking part in a collaborative focused on tracking data to identify whether there are racial and ethnic disparities in the cardiac treatment they provide while at the same time working to improve the quality of care, the foundation reports (www.rwjf.org).

While U.S. hospital leaders say they provide the same level of care regardless of race and ethnicity, few know for sure, the RWJF report contends, because most 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, the report says, and hardly any hospitals use data to determine how their care of minority patients compares to other known quality standards.

The Expecting Success program, as it is called, is helping the 10 hospitals produce consistent data on more than 20 cardiac care quality indicators, all analyzed by patient race, ethnicity, and language.

The program's staff suggest several key steps to help begin the data collection process:

  • Gather opinions from top to bottom.

It's important to discuss the purpose and process for data collection with everyone from the CEO to front-line staff.

  • Affirm the legality of the process.

Some hospitals think it's illegal to collect these data, but published research from a variety of sources affirms its legality for improving quality.

  • Identify the time and place for data collection.

All sites involved in the program determined a time, place, and person responsible for gathering the data. It usually takes place at registration.

  • Think through the technology issues.

Information technology staff must ensure the data transfers to all relevant patient databases — including programs that track the specific care received.

  • Use consistent categories.

The current race and ethnicity categories used by the Office of Management and Budget are the recommended standard.

  • Have patients provide the information.

All sites rely on patients or their caregivers to provide the information, rather than registration staff "eyeballing" patients.

  • Provide detailed staff training.

Sites provided sample scripts, role-playing, and trouble-shooting scenarios to make registration staff comfortable.

The Health Research & Educational Trust, a division of the American Hospital Association, has developed a toolkit to guide hospitals through the process of collecting data on race, ethnicity, and primary language.

The kit, which includes nuts and bolts information, such as sample scripts and other resources for training staff, can be accessed at www.hretdisparities.org.