Health Care Organizations' Use of Data on Race/Ethnicity to Address Disparities in Health Care

Abstract

Publication of the Institute of Medicine report Unequal Treatment (Smedley, Stith, and Nelson 2003) represented a key transition point in the field of disparities research. Up to that point, the vast majority of studies had been descriptive in nature, documenting racial/ethnic and socioeconomic disparities in specific domains of clinical care. Researchers, funding agencies, and health care policy-makers agree, however, that studies of racial/ethnic disparities should move beyond documenting disparities to focus on either understanding the causes of disparities or the development and testing of interventions designed to reduce or eliminate disparities. Such a movement is already occurring, as several recent papers provide sophisticated analyses of either underlying mechanisms or approaches to eliminating disparities (Earle et al. 2002, Tammemagi et al. 2004) Understanding these underlying mechanisms, though, is only a step toward actually reducing or eliminating disparities. Given the range of potential causes of disparities, elimination of disparities will require action at several levels: federal policy; state and local policy; public and private purchasers of health care; health plans; large organizational providers like hospitals and medical groups; individual providers; patients and family members; and community groups. The potential actions of federal, state, and local policy-makers have been described elsewhere (Lurie, Jung, and Lavizzo-Mourey 2005). Governmental action by itself is unlikely to eliminate disparities in health care, however, as many of the proximal causes of disparities are based in policies and behaviors of the health care delivery system that are beyond the reach of government. Reduction of racial and ethnic disparities in the quality of health care will require action by health care organizations—health plans, hospitals, medical groups, and individual health care providers—as well. Many initiatives addressing health care disparities will involve engaging health care organizations that have an existing infrastructure for quality measurement and quality improvement in the effort to reduce disparities (Nerenz 2005). In order to design and test interventions whose purpose is reducing disparities in care, these organizations need accurate racial and ethnic data on the populations they serve. In addition to a quality measurement and quality improvement infrastructure, many health care organizations have, or can obtain, data on the race/ethnicity of the members or patients they serve. Experts have raised legitimate concerns about the accuracy and completeness of racial and ethnic data in many settings, though the data that do exist have been adequate for a wide range of projects to date (Bierman et al. 2002). A general “template” for projects to address disparities at the local organizational level has emerged from projects set in the context of managed care plans (Nerenz and Darling 2004). Obtaining data on race/ethnicity of plan members or patients is an essential part of that template, as subsequent steps in the process (e.g., creating quality of care measures stratified by race/ethnicity, creating culturally appropriate patient education materials) depend on having that information at the individual patient or member level.