Collection of Race, Ethnicity, and Language Preference Data in a Complex
Healthcare Organization
Brian Currie, MD, MPHMontefiore Medical Center
Bronx, NY
Goals:1. Focus on the “nuts and bolts” of improving the collection of race, ethnicity, and preferred language data
2. Identify and address potential obstacles in implementing initiatives to capture better data gleaned from the Montefiore experience
3. Begin to outline the institutional “cultural” change that resulted from access to accurate and actionable race, ethnicity, and preferred language data
This information is provided under Section 2805-m of the New York State Public Health Law
4
M a n a g e d C a reI n fr a s tr u c tu re
E H ITI n fo r m a tio n T e c h n o lo g ies
E m e r g e n cyD e p t.
M e d ic a l G r o u p
A m b u la to ryS p e c ia lty C a re
A m b u la to ryC a re
M o s e s D iv6 2 0 b e d s
C H A M1 0 6 b e d s
E in s te in D iv .3 9 6 b e d s
N o r th D iv .3 6 9 b e d s
In p a tie n tC a re
C e r tifie d H H AL T H H P
H o m e c a re
R e h a b ili ta tio nU n it
P o s t-A cu te &L o n g te rm C a re
P r im a r y C a reto U n d e r s e r v ed
C a r e fo rS p e c ia l P o p u la tio n s
P r e v a le n tC h r o n ic D is e a s es
C o m m u n ityS ervic es
M on tefiore
Acute Care: 100,000 discharges / 260,000 ED visits Ambulatory and Home Care: 2.5 million visits / 500,000 home care visits
The Montefiore Delivery System
This information is provided under Section 2805-m of the New York State Public Health Law
The Bronx, New YorkBronx U.S.A.
Total population 1.4 million 300 million
Population below age 18 30% 25%
Individuals below poverty level 29% 13%
Foreign born 32% 12%
Speak other than English at home (> 5 y.o.) 57% 19%
African-American/Black race 33% 12%
Hispanic/Latino ethnicity 51% 15%
Robert Wood Johnson Foundation Expecting Success: Excellence in Cardiac Care
National Program Objectives•Improve cardiovascular (acute myocardial infarction and congestive heart failure) care for African Americans and Latinos
•Develop improvement strategies and models for inpatient and outpatient settings
•Share lessons with health care providers and policymakers nationwide
A QI Collaborativewww.expectingsuccess.org
This information is provided under Section 2805-m of the New York State Public Health Law
The Montefiore Project
Objective Interventions
Standardize collection of demographic data
Train registration staff and modify information systems
Improve AMI and CHF care for all MMC patients
Patient and provider centered materials, improvement methods
Evaluate quality of care by demographic group
Monthly reporting of AMI and CHF measures by demographic group
Improve communication with post discharge providers CHF-specific discharge planning
BOSTON POST RD
MOSES DIVISION
WEILER DIVISION
MONTEFIORE MEDICAL PARK
YONKERS DATA CENTER
DOBBS FERRY HOSPITAL
BUHREAVE
Monte Net• >150 Registration Areas• >1500 Registrars
CROSS COUNTY
HARRISON
FORDHAM FAMILY WEST FORDHAMROAD
CFCCCHCC
1982/1894EASTCHESTER
CMO
MARBLE HILL
FORDHAM HEALTHCENTER
CASTLE HILL
NORWOODUNIVERSITY
FAMILY HEALTHCENTER
WILLIAMSBRIDGE
WEST FARMS
AGING INAMERICA
PROSPECT
WHITE PLAINS
JOHNSON AVE.
MARBLEHILL
KINGSBRIDGE
HENRY HUDSONPKWY
PARKCHESTER
BURKEAVE
4514 BAINBRIDGE
HARTSDALE
LEGEND
BULLARD AVE
METHADONE
BAINBRIDGENURSING HOME
JEROME AVEFAMILY PRACTICE SONET
HIGH SPEED SERVICEFRAME RELAY56K SERVICE
FRAME RELAYT1 SERVICE
MMC FIBEREXTENSION
ST. LAWRENCE
MARAN PLACE
CO-OP CITY
LARCHMONT
SOUTH BRONXCHILDRENS HEALTH
3550 JEROME
ASTORMAMARONECK
2005 JEROME
WAKEFIELD
BARNES AVE
MEDICAL ARTSPAVILION
FORDHAM PLAZA
World Wide Web
EDI toOutsideEntities
AIDS MENTAL HEALTH
The Registration Community
This information is provided under Section 2805-m of the New York State Public Health Law
Fields and Categories• Process
– Required fields– Ethnicity first– Patients self identify status
• Ethnicity– Hispanic or Latino– Not Hispanic or Latino– Declined– Patient unavailable
• Preferred language– [Numerous]– Declined– Other– Patient unavailable
• Race– American Indian or Alaskan Native– Asian– Black or African American– Native Hawaiian or Other Pacific
Islander– White– Multiracial: Asian/Black-African
American– Multiracial: Asian/White– Multiracial: Black-African
American/White– Multiracial: Other combination– Declined– Patient unavailable
This information is provided under Section 2805-m of the New York State Public Health Law
Implementation Factors• Management
– Registration Quality Unit– Expertise
• Content: HRET, NPO• Process
– Health information management
– Customer services– EHIT– Performance
improvement
• Data use– Optimal categories– Recoding old data to new– Interfaces– Monitoring
• Workflow– Field order– Number of categories– Specific issues
• “Other”• Patient not present• Patient refusal
– Hard vs. soft stops– Different care settings
• Education– Staff training– Questions from patients
and families
This information is provided under Section 2805-m of the New York State Public Health Law
Discharges with Unknown Demographics at Montefiore 2005 vs. 2007
62%
9%
97%
47%
3%
29%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Race Ethnicity Preferred Language
Calendar 2005 (N=65,228) Calendar 2007 (N=70,758)
Registration Results
This information is provided under Section 2805-m of the New York State Public Health Law
All Recommended AMI and CHF Care
AMI and CHF Patients Receiving All Recommended Care Montefiore: Q1 '06 to Q1 '08
68%65%
77% 75%79%
84%
75%
83% 85%
47% 49%
57% 56%59% 62% 63% 61%
78%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Q1-06 Q2-06 Q3-06 Q4-06 Q1-07 Q2-07 Q3-07 Q4-07 Q1-08
AMI: All Care CHF-All Care
This information is provided under Section 2805-m of the New York State Public Health Law
All Recommended AMI Care by Demographic Group: Montefiore CY 2007
80% 78% 79% 81% 80% 79%83%
0%10%20%30%40%50%60%70%80%90%100%
All(N=478)
Black(N=124)
White(N=154)
Hispanic(N=154)
Non-Hispanic(N=265)
English(N=362)
Spanish(N=77)
AMI Care by Demographic Group
Race Ethnicity Preferred Language
This information is provided under Section 2805-m of the New York State Public Health Law
Analyzing OutcomesCardiovascular Disease
Today Tomorrow?30 Day Same Cause Readmission Rate, by Diagnosis
Montefiore 2007
8.0%
3.0%
13.4%
2.5%
1.9%
0% 2% 4% 6% 8% 10% 12% 14%
AllCardiovascular
(N=3189)
AMI (N=398)
CHF (N=1614)
Diabetes (N=606)
Stroke (N=571)
30 Day Same Cause Readmission Rate, by Demographic: Montefiore 2007
8.0%
7.1%
9.0%
8.5%
6.4%
7.9%
7.3%
0% 2% 4% 6% 8% 10%
All Cardiovascular(N=3189)
Black (N=1143)
White (N=824)
Hispanic (N=1124)
Non-Hispanic(N=1789)
English (N=2546)
Spanish (N=524)
This information is provided under Section 2805-m of the New York State Public Health Law
Healthcare Management ImplicationsToday’s Functions Tomorrow’s Products or Services
Health information management Language specific forms
Quality improvement Care evaluation by demographic group
Patient education Patient-centered materials
Nutrition Specific dietary advice
Customer services Accurate interpretive service needs
Care management Care management by demographic group
Information technology Point of care decision support
Research Demographic-specific “translation”
Some Resources• Expecting Success: Excellence in Cardiac Care
– http://www.expectingsuccess.org• Health Research and Educational Trust
– http://www.hretdisparities.org• Massachusetts General Hospital Disparities Solutions Center
– http://www2.massgeneral.org/disparitiessolutions
This information is provided under Section 2805-m of the New York State Public Health Law