Responses of Massachusetts hospitals to a state mandate to collect race, ethnicity and language data from patients: a qualitative study.

John Z Ayanian,Selena Jorgensen,Robin M Weinick,Ruth Thorlby

doi:10.1186/1472-6963-10-352

John Z Ayanian, Selena Jorgensen + Show 2 more

Open Access

https://doi.org/10.1186/1472-6963-10-352

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Abstract

BackgroundA Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients' race, ethnicity and preferred language using standardized methodology based on self-reported information from patients. This study assessed implementation of the regulation and its impact on the use of race and ethnicity data in performance monitoring and quality improvement within hospitals.MethodsThematic analysis of semi-structured interviews with executives from a representative sample of 28 Massachusetts hospitals in 2009.ResultsThe number of hospitals using race, ethnicity and language data internally beyond refining interpreter services increased substantially from 11 to 21 after the regulation. Thirteen of these hospitals were utilizing patient race and ethnicity data to identify disparities in quality performance measures for a variety of clinical processes and outcomes, while 16 had developed patient services and community outreach programs based on findings from these data. Commonly reported barriers to data utilization include small numbers within categories, insufficient resources, information system requirements, and lack of direction from the state.ConclusionsThe responses of Massachusetts hospitals to this new state regulation indicate that requiring the collection of race, ethnicity and language data can be an effective method to promote performance monitoring and quality improvement, thereby setting the stage for federal standards and incentive programs to eliminate racial and ethnic disparities in the quality of health care.

Highlights

A Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients’ race, ethnicity and preferred language using standardized methodology based on self-reported information from patients
The Institute of Medicine’s (IOM) 2003 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, highlighted the need to transition from describing disparities to developing methods by which they can be reduced[2]
In July, 2009, letters requesting participation in a study about the state regulation were sent to the chief executive officers (CEOs) of the 41 health systems representing the 56 hospitals in the sample

Summary

Introduction

A Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients’ race, ethnicity and preferred language using standardized methodology based on self-reported information from patients. The standardized collection of data on patients’ race, ethnicity, and preferred language has been widely recognized as a necessary step to improve the quality of care by developing effective interventions to reduce disparities[4,5,6,7,8,9,10]. The Massachusetts Division of Health Care Finance and Policy (DHCFP) issued new regulations requiring all acute-care hospitals to collect patients’ selfreported race, ethnicity and preferred language with a standardized approach (Additional file 1), including an expanded list of 33 ethnic groups[11]. The Massachusetts Hospital Association (MHA) provided training and support materials [12] and sponsored four regional training sessions for hospitals in the fall of 2006 to explain the requirements

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