Educate registrars on reason to collect data

You need patient's race, ethnicity

Patients expect to be asked questions about their address and insurance coverage in registration areas, but they might be startled or annoyed to be asked questions about their race, ethnicity, and language.

Last year Cincinnati (OH) Children's Hospital Medical Center retrained over 400 registrars on how to collect race, ethnicity, and language information.

"Our work here is linked to the Greater Cincinnati Health Council," explains Michelle Gray, MHA, director of patient access and outpatient registration. The council is leading the work of Cincinnati Expecting Success as part of Cincinnati Aligning Forces for Quality, an initiative of the Health Collaborative and the Robert Wood Johnson Foundation.

"We, along with 32 other hospitals in the tri-state area, have been working to use the same categories in collecting race, ethnicity, and language data," says Gray. "This is a vital first step in analyzing indicators of care for specific patient populations."

The training of registrars focused on the reason for obtaining the information and how to ask for it appropriately. "We also trained the registrars on why it's important to ask the patient their race and ethnicity, instead of 'eyeballing' them and trying to guess," says Gray.

To illustrate this point, a role-playing exercise was used, based on a real-life example of a family with multi-racial children. Registrars viewed a picture of the siblings during a slide presentation and were asked to identify their race and ethnicity. "After the exercise, there was a group discussion. A direct quote from the children's father was shared with the group," says Gray. The father stated, "When given the option, we select all the races that the kids are. My wife's father is African-American, and her mother is from Mexico. I'm Caucasian."

He further explained, "When we are not given choices, and must select one race, and "other" is not an option, we select Caucasian, as the kids are 50% Caucasian, 25% African-American and 25% Hispanic."

Gretta Heath, a patient access trainer at the hospital, said that with this example, "registrars learned the importance of allowing families to self-identify."

Staff were informed that some diseases and conditions are race-specific, so the race data can be matched with clinical data to address any disparities in the quality of care patients are receiving, says Gray.

"The order in which we ask the questions is important," adds Heath. Experience has shown that better quality information is recorded when the ethnicity question is asked first, she says. For example, asking the ethnicity question first helps decrease the confusion about how a Hispanic person would identify themselves. "Sometimes Hispanics do not identify themselves with any of the race categories," she says. "When the race question is asked first, they will reply with terms actually used to describe their ethnicity."

Registrars use a laminated card with responses for common questions or reactions from patients, which has helped to increase their comfort in asking for the information, reports Gray.

"We had been collecting this information for years. What was new was the importance of why we collected it," says Gray.


For more information about training registrars to collect data on race, ethnicity, and language, contact:

• Michelle C. Gray, MHA, Director, Patient Access/Outpatient Registration, Cincinnati (OH) Children's Hospital Medical Center. Phone: (513) 636-1414. Fax: (513) 636-7531. E-mail: