REAL Data Collection Essential for Care of Vulnerable Populations

Abstract

With minorities projected to constitute a majority of the U.S. population by 2043 (Census Bureau, 2012)-and considering that the disparities in healthcare access and quality they face are well documented (CDC, 2011)-it's clear that improving care for this population will depend on understanding who they are and where gaps exist. The need to reduce disparities in care has become particularly pressing with the Affordable Care Act's (ACA) focus on value-based care and quality improvement and a growing recognition that a reformed, high-performing healthcare system must make eliminating disparities a fundamental goal. We can achieve this goal by providing the best care possible to society's most vulnerable.Low-income and other disadvantaged patients are a population that members of America's Essential Hospitals (formerly the National Association of Public Hospitals and Health Systems) know well and a key reason we have joined forces with our allies in the Equity of Care initiative. Essential hospitals-those that serve a safety net role in their communities-are uniquely positioned to help reduce healthcare disparities, as more than half our patients are racial and ethnic minorities and a majority are uninsured or qualify for Medicaid. Although our members represent just 2% of U.S. hospitals, they deliver nearly 20% of all uncompensated care (NAPH, 2012).So, collecting reliable race, ethnicity, and language (REAL) data-and viewing it as an essential component of quality improvement-has become a priority for us and our hospitals, as it should be for all healthcare providers.WHY REAL DATA IS IMPORTANTIt seems self-evident, but this tenet is often overlooked: To provide the best quality of care to your patient population, you need to know who your patients are. REAL data helps you understand your patients' varying needs and view treatments and outcomes through the lens of their rich ethnic and racial diversity. It drives better care and a better patient experience. It enhances prevention-risk of disease varies by ethnicity and race, making this information as important to the future as it is to the present. It supports culturally competent care that respects each patient's social and cultural background and aids communication to improve patient compliance and outcomes.While improving patient care and the patient experience is the primary reason for collecting REAL data, regulatory and other compliance issues also come into play- meeting federal requirements for meaningful use of health information technology, for example, and achieving patient-centered medical home certification. Collecting REAL data is always the right thing to do and often the required thing to do.WORK TO DATE, AND MOVING FORWARDIn 2011, the Equity of Care National Call to Action made collecting and using REAL data a key component of a three-pronged approach to reducing disparities that also seeks increased cultural competency training and leadership diversity (Equity of Care, 2011).Other national stakeholders over the past decade have joined the fight to improve equity, including through better collection of data. In 2001, the Institute of Medicine (lOM) report Crossing the Quality Chasm: A New Health System for the 21st Century named equity as one of six domains of quality that all healthcare organizations must address. Other important milestones along the way, particularly with respect to REAL data, include the 2009 American Recovery and Reinvestment Act and its meaningful use requirements; the 2010 ACA, with its requirement that federally funded programs collect data on race, ethnicity, primary language, disability status, and gender; the 2011 federal Action Plan to Reduce Health Disparities, which outlines ways to increase health equity, including upgrading collection and analysis of REAL data and other demographics consistent with the ACA; and The Joint Commission's 2012 patient-centered communication standards, which require hospitals to collect a patient's preferred language for both verbal and written communications regarding their care. …