There are recent changes in how you are registered at a hospital. These changes are based on years of research with the goal being improved care for all. It is good to be prepared, so here is a bit of background information. The Institute of Medicine (IOM)'s landmark report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" (2002) identified that access, quality, delivery and outcomes of health care are lower for racial/ethnic minorities and those with limited language proficiency. According to the 2008 National Healthcare Disparities Report (AHRQ), racial/ethnic disparities refer to differences in the quality of health care received by members of different racial/ethnic groups that are not explained by other factors. Specifically, research identified that health care disparities are responsible for certain groups being less likely to receive cancer screening, appropriate cardiac care, transplants, most effective RA medicines, hip and knee replacements, and effective pain management. According to the Joint Center for Political and Economic Studies (2009), racial health disparities in infant mortality, chronic disease and many other metrics cost the U.S. health system more than $57 billion a year.
To help assure quality care for all, federal mandates have been issued requiring capture of information on race, ethnicity and language (R/E/L)* data as self-reported by patients or their caregivers. New regulations from The Joint Commission, the Affordable Health Care Act, and CMS require hospitals to identify/address these health care disparities. The result is that all patients having examinations/procedures performed at a hospital will be asked questions related to R/E/L. By collecting this information, the federal government believes that it can ensure that all patients receive high-quality care. Collecting this data is an obligation as part of a national cohort to study health care processes and optimize outcomes. In order to assure that data collection is uniform, no assumptions are allowed. Data is collected from all patients, no exceptions. Careful staff training is required for consistent, accurate, professional, and complete data capture. Staff training includes how to:
- Describe the reasons that the collection of R/E/L is being standardized
- Define and give examples of ethnicity and race
- Feel comfortable in using scripts to ask patients to self-identify
- Handle difficult patient responses
According to the Journal of General Internal Medicine's "Patients' Attitude Toward Health Care Providers Collecting Information About Their Race and Ethnicity," most patients (80 percent) think hospitals should be collecting this data and most patients (97 percent) think it is important for hospitals to examine differences in quality.
Because I was unaware of this initiative prior to it being enacted, I automatically presume others are also unaware. Many years, manpower hours and tax dollars must have been spent thinking about how to provide better health care to all citizens. I cannot help but ask several questions regarding this mandated initiative. How will this information be used? Will this information help improve health care, help save money, etc.? Clearly, the government thinks this data will be beneficial. So to be prepared for these unusual and personal questions when interacting with hospital staff, my recommendation is that you please remember that the staff is only doing their job; don't get angry with the messenger.
*R/E/L as categorized by the Office of Management and Budget (OMB):
Race: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White, Some Other Race, Declined, Unavailable
Ethnicity: Social groups with a shared history, sense of identity, geography and cultural roots, which may occur despite racial differences -- Hispanic or Latino, Non-Hispanic or Latino, Declined, Unavailable
Preferred language: The language a patient feels most comfortable when discussing health care concerns or reading medical or health care instructions -- Declined, Unavailable
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