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