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HRET Health Research & Educational Trust of New Jersey
ResearchOngoing Projects
Patient Race and Ethnicity: Improving Hospital Data Collection and Reporting
Report Table of Contents: Project Overview
Patient Race and Ethnicity: Improving Hospital Data Collection and Reporting is the second report presented to NJHA member hospitals as part of an NJHA effort to ensure that all data reported by hospitals and submitted to the state Department of Health and Senior Services (DHSS) are accurate and reliable. This resource has been prepared by HRET as part of its data reporter functions. Using quality control measures, HRET studies hospitals' data on patient race and ethnicity, provides feedback on their reporting practices and assists them in identifying challenges and barriers to accurately collecting, coding and reporting these data and exploring opportunities to improve them. In addition, HRET identifies typical problem areas and develops interventions to educate hospital staff about the issues and improvement strategies for quality control and accurate and reliable data submission by hospitals.
Healthcare Disparities: Importance Of Accurate Reporting
Given the dramatic increase in minority and immigrant populations in New Jersey and the substantiated disparities in healthcare access, service utilization and health outcomes at state and national levels, it is critical that hospitals accurately reflect the populations they serve and develop effective interventions to reduce these disparities. One major source of data for the racial and ethnic background of patients hospitals use to identify areas of disparity and need is the UB-92 discharge data from the New Jersey Discharge Data Collection System (NJDDCS). Hospitals rely heavily on these data fields in the design of service interventions that target identified gaps and are responsive to the needs of racially and ethnically diverse patients. It is therefore critically important that these fields accurately and reliably represent the race and ethnicity of the patients that hospitals serve. Furthermore, hospital discharge data may be used by the DHSS and other organizations for a number of purposes such as reviewing and considering Certificate of Need applications; assessing access of minorities to specific services, including cardiac care and other services; and planning, implementing and evaluating health programs designed to improve the health status of underserved and disenfranchised populations. The accuracy and reliability of race and ethnicity fields of this data set have become a greater concern to healthcare facilities, as the data may also be used by the DHSS to determine the degree to which hospitals are serving minorities in their communities and working to narrow the gaps and disparities in service utilization of racial and ethnic groups.
HRET's Studies On This Issue
Many studies have documented persistent undercounting and misclassification of certain ethnic and racial categories and have raised concerns about inconsistency and quality issues regarding these data fields at national, state and local levels. Underreporting and misclassification problems originate in the admitting process where the information may be assumed, may not have been asked appropriately or simply may not be solicited from patients. In 1996 HRET issued a report on its first study that examined the quality of the race and ethnicity collecting, coding and reporting in hospital discharge dataset, using 1995 discharges. The study found a wide variation among hospitals in these fields, suggesting either a utilization issue or a significant over - or underreporting of utilization of services for certain racial and ethnic categories, mainly Hispanics. A closer look at individual hospital data indicated that hospitals' collecting and coding practices were a significant source of the problem. To address this issue, HRET developed resources and offered educational sessions in 1996 to assist hospitals with their race and ethnicity coding improvement efforts. The changes in the race and ethnicity categories of the Census 2000 data collection instruments and their incompatibility with categories used in NJDDCS prompted HRET to revisit the race/ethnicity data quality issue. Using 1995 data as a baseline, the new study examined the distribution of race and ethnicity for all patients hospitalized in New Jersey acute care hospitals, as reflected in discharge data, from 1996 through 2002, specifically looking at any improvements or changes across time. The analyses were performed generally for statewide data as well as specifically for individual hospital-level data. To further validate the findings, the distribution of patients' reported race and ethnicity was compared with that of the state populations or the geographic areas each hospital serves, mainly its county and municipality, using the most recent Census data. For each hospital, patients' reported races and ethnicities were compared from 1995 to 2002, and hospitals with problems and significant fluctuations in major race and ethnic categories were identified. The findings show that although many hospitals have made significant improvement in the collection and coding of their patient race and ethnicity data, coding inconsistency seem to persist and continue to be a concern for some hospitals. HRET asked hospitals to review this report and their hospital-specific data to determine if there are significant fluctuations in their hospital reporting that may not be considered as improvement over time, and if there is a need to implement measures to improve their practices of collecting, coding or reporting patient race and ethnicity data. Improved accuracy and reliability of these data fields will help hospitals and the state better identify areas of healthcare disparity in their communities and more objectively assess their community needs. It will also allow them to more effectively plan culturally appropriate service interventions that would address the individual needs of racially and ethnically diverse patients and improve the access and quality of care for minority, underserved and disfranchised populations, ultimately improving the health of these populations in New Jersey.
HRET's Educational Plans
Recently, many other studies have also focused on inconsistencies and limitations of health-related data and underscored the need for a standardized data collection process and recommended a routine channel of communication and consistent training for intake workers on the importance of race and ethnicity data collection and its use. HRET is planning quality control and improvement measures to assure more accurate and reliable data submission by hospitals, including development of interventions, educational tools and staff training programs to support hospital improvement efforts. In addition, arrangements with the DHSS was initiated for adjusting race and ethnicity categories of hospital discharge data and making them standardized, consistent and compatible with the Census 2000 categories. These changes will be reflected in the resources and tools prepared by HRET. Certainly there are areas for improvements in all hospitals and HRET is committed to support them in their endeavors. Publications
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