Collection of Race, Ethnicity, and
Language Preference Data in a Complex
Healthcare Organization
Brian Currie, MD, MPH
Montefiore 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
The Montefiore Delivery System
Montefiore
Ambulatory
Care
Managed Care
Infrastructure
EHIT
Information Technologies
Inpatient
Care
Post-Acute &
Long term Care
Emergency
Moses Div
Dept.
620 beds
Medical Group
CHAM
106 beds
Ambulatory
Specialty Care
Einstein Div.
396 beds
Homecare
Community
Services
Primary Care
to Underserved
Certified HHA
LTHHP
Rehabilitation
Unit
Care for
Special Populations
Prevalent
Chronic Diseases
North Div.
369 beds
Acute Care: 100,000 discharges / 260,000 ED visits
4
Ambulatory and Home Care: 2.5 million visits / 500,000 home care visits
This information is provided under Section 2805-m of the New York State Public Health Law
The Bronx, New York
Bronx
U.S.A.
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%
Total population
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 Collaborative
www.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
The Registration Community
World Wide
Web
EDI to
Outside
Entities
SOUTH BRONX
CHILDRENS HEALTH
MEDICAL ARTS
PAVILION
BAINBRIDGE
NURSING HOME
HARTSDALE
LARCHMONT
WEST FARMS
CO-OP CITY
WHITE PLAINS
BURKE
AVE
CMO
CASTLE HILL
AIDS MENTAL
HEALTH
MARAN PLACE
2005 JEROME
UNIVERSITY
3550 JEROME
NORWOOD
BUHRE
AVE
PARKCHESTER
BARNES AVE
ASTOR
MAMARONECK
WAKEFIELD
CHCC
MARBLE
HILL
YONKERS DATA CENTER
HENRY HUDSON
PKWY
CROSS COUNTY
MOSES DIVISION
Monte Net
• >150 Registration Areas
• >1500 Registrars
WEILER DIVISION
ST. LAWRENCE
JOHNSON AVE.
FORDHAM PLAZA
LEGEND
MONTEFIORE MEDICAL PARK
MARBLE HILL
HARRISON
1982/1894
EASTCHESTER
FORDHAM FAMILY
CFCC
WILLIAMSBRIDGE
DOBBS FERRY
HOSPITAL JEROME AVE
FAMILY PRACTICE
BOSTON
POST
RD
4514 BAINBRIDGE
FRAME RELAY
T1 SERVICE
KINGSBRIDGE
PROSPECT
WEST FORDHAM
ROAD
SONET
HIGH SPEED
SERVICE
FRAME RELAY
56K SERVICE
BULLARD AVE
FORDHAM HEALTH
CENTER
AGING IN
AMERICA
METHADONE
This information is provided under Section 2805-m of the New York State Public Health Law
FAMILY HEALTH
CENTER
MMC FIBER
EXTENSION
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
Registration Results
Discharges with Unknown Demographics at Montefiore
2005 vs. 2007
100%
97%
90%
80%
70%
62%
60%
47%
50%
40%
29%
30%
20%
9%
10%
3%
0%
Race
Ethnicity
Calendar 2005 (N=65,228)
Preferred Language
Calendar 2007 (N=70,758)
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
100%
90%
84%
77%
80%
70%
68%
50%
79%
75%
47%
49%
Q1-06
Q2-06
57%
56%
Q3-06
Q4-06
59%
85%
78%
75%
65%
60%
83%
62%
63%
61%
Q2-07
Q3-07
Q4-07
40%
30%
20%
10%
0%
AMI: All Care
Q1-07
CHF-All Care
This information is provided under Section 2805-m of the New York State Public Health Law
Q1-08
AMI Care by Demographic Group
All Recommended AMI Care by Demographic
Group: Montefiore CY 2007
100%
Race
Ethnicity
Preferred
Language
90%
80%
80%
78%
All
(N=478)
Black
(N=124)
70%
79%
81%
80%
83%
79%
60%
50%
40%
30%
20%
10%
0%
White Hispanic NonEnglish Spanish
(N=154) (N=154) Hispanic (N=362)
(N=77)
(N=265)
This information is provided under Section 2805-m of the New York State Public Health Law
Analyzing Outcomes
Cardiovascular Disease
Today
Tomorrow?
30 Day Same Cause Readmission Rate, by
Demographic: Montefiore 2007
30 Day Same Cause Readmission Rate, by Diagnosis
Montefiore 2007
0%
2%
4%
All
Cardiovascular
(N=3189)
6%
8%
10%
12%
14%
0%
4%
6%
8%
All Cardiovascular
(N=3189)
8.0%
Black (N=1143)
AMI (N=398)
2%
10%
8.0%
7.1%
3.0%
White (N=824)
13.4%
CHF (N=1614)
Hispanic (N=1124)
Non-Hispanic
(N=1789)
Diabetes (N=606)
8.5%
6.4%
2.5%
English (N=2546)
Stroke (N=571)
9.0%
7.9%
1.9%
Spanish (N=524)
This information is provided under Section 2805-m of the New York State Public Health Law
7.3%
Healthcare Management Implications
Today’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