We Were All Created Equal – Man Made Us Different.

by Christopher Cornue

Next, how do we measure disparities? Most commonly, it can be accomplished through the collection of race, ethnicity and language data. While this may appear to be easy, many hospitals struggle to identify the best manner to collect this information. Many hospitals struggle with the categories they create. Others struggle with their healthcare employee’s belief that this may be offensive to patients and/or they feel awkward about asking the question. Organizations such as the Health Research and Education Trust (HRET) arm of the American Health Association (www.hret.org) have been helping organizations to address this issue for several years. Using well established classification systems, organizations can systematically collect and monitor the type of care they are providing to their patients. Some initiatives have incorporated the collection of these data, such as the Robert Wood Johnson Foundation’s Expecting Success: Excellence in Cardiac Care project, a national project looking to address disparities in cardiovascular care. This project will be discussed in an upcoming posting. Regardless of the approach, however, it is clear that all organizations will be expected to pay closer attention to disparities, and with that, collect this race, ethnicity and language data.

The collection of this information is on all of our “front doorsteps.” As recently as 29 March 2007, The Joint Commission released a report recommending broad strategies designed to help hospitals overcome issues, such as language and cultural competency in the delivery of care. The report reviewed 60 hospitals nationwide and found that interpreter services and culturally appropriate care is practiced inconsistently. Reasons such as staffing challenges and financial strains were most commonly cited. The report stated that hospitals should establish a centralized program to coordinate these services. Additionally, a uniform system of capturing racial, ethnic and lingual information for each patient should be implemented. Further, they recommended that hospitals adopt policies to ensure patient family members do not become the medical interpreter, unless in extreme emergencies. Finally, they encouraged an increased engagement of the community in these issues. It has been widely believed that the Joint Commission will be requiring that surveyors review each hospital to ensure they are collecting race, ethnicity and language data in the hospital accreditation surveys, and this report confirms that it will be occurring soon, possibly as soon as your next survey…

Our final two posts will look at specific, large-scale efforts to eliminate disparities. One focusing on breast cancer mortality and the other on cardiovascular disease in African-Americans and Hispanics.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics