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Variability in Collection and Use of Race/Ethnicity and Language Data in 93 Pediatric Hospitals

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Abstract

Objective

To describe how pediatric hospitals across the USA and Canada collect race/ethnicity and language preference (REaL) data and how they stratify quality and safety metrics using such data.

Methods

Pediatric hospitals from the Solutions for Patient Safety network (125 US, 6 Canadian) were surveyed between January and March 2018 on collection and use of patient/family race/ethnicity data and patient/family language preference data. The study team created the survey using a formal process including pre­testing. Responses were analyzed using descriptive statistics.

Results

Ninety­three of 131 (71%) hospitals completed the survey (87/125 [70%] US, 6/6 [100%] Canadian). Patient race/ethnicity was collected by 95%, parent/guardian race/ethnicity was collected by 31%, and 5/6 Canadian hospitals collected neither. Minimum government race/ethnicity categories were used without modification/addition by 68% of US hospitals. Eleven hospitals (13%) offered a multiracial/multiethnic option. Most hospitals reported collecting language preferences of parent/guardian (81%) and/or patient (87%). A majority provided formal training on data collection for race/ethnicity (70%) and language preferences (70%); fewer had a written policy (41%, 51%). Few hospitals stratified hospital quality and safety measures by race/ethnicity (20% readmissions, 20% patient/family experience, 16% other) or language preference (21% readmissions, 21% patient/family experience, 8% other).

Conclusions

The variability of REaL data collection practices among pediatric hospitals highlights the importance of examining the validity and reliability of such data, especially when combined from multiple hospitals. Nevertheless, while improvements in data accuracy and standardization are sought, efforts to identify and eliminate disparities should be developed concurrently using existing data.

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Abbreviations

REaL:

Race/ethnicity and language

SPS:

Solutions for Patient Safety

OMB:

Office of Management and Budget

IOM:

Institute of Medicine

HHS:

Health and Human Services

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Funding

This study received funding from the Center for Medicare & Medicaid Services (CMS) Partnership for Patients Program.

Author information

Authors and Affiliations

  1. Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA

    John D. Cowden, Gabriela Flores & Tiffany Chow

  2. Children’s Medical Center Dallas, 1935 Medical District Drive, Mailstop K4.01, Dallas, TX, 75235, USA

    Patricia Rodriguez & Tracy Chamblee

  3. Central Connecticut State University, 1615 Stanley St, New Britain, CT, 06053, USA

    Megan Mackey

  4. UH Rainbow Babies and Children’s Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Anne Lyren

  5. Children’s Hospital of Wisconsin, 8915 W. Connell Court, Milwaukee, WI, 53226, USA

    Michael F. Gutzeit

Authors
  1. John D. Cowden
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  2. Gabriela Flores
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  3. Tiffany Chow
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  4. Patricia Rodriguez
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  5. Tracy Chamblee
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  6. Megan Mackey
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  7. Anne Lyren
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  8. Michael F. Gutzeit
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Corresponding author

Correspondence to John D. Cowden.

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Appendix

Appendix

SPS REaL (Race, Ethnicity, & Language) Data Survey Questions

Race and ethnicity data collection

  1. 1.

    Does your hospital routinely gather information on the race and/or ethnicity of patients for inclusion in the medical record (for example, during patient registration or intake)? Y/N

  2. 2.

    Does your hospital routinely gather information on race and/or ethnicity of parents/guardians for inclusion in the medical record (for example, during patient registration or intake)? Y/N

  3. 3.

    Does your hospital only use the US government’s standard “OMB” (Office of Management and Budget) options for race and ethnicity as shown below without modification or addition (for example, no “multiracial,” “other,” “declined,” etc.)?: Y/N

Question 1—Hispanic (yes/no)

Question 2—Race:

  • American Indian or Alaska Native

  • Asian

  • Black or African American

  • Native Hawaiian or Other Pacific Islander

  • White

Please provide the questions and options for race and/or ethnicity used at your hospital (exact wording, if possible): ______________________________________________

  1. 4.

    Does your hospital have a written policy on how to ask families about race and/or ethnicity? Y/N

  2. 5.

    Does your hospital have formal training for staff on how to ask families about race and/or ethnicity? Y/N

Race and ethnicity data use

  1. 6.

    Does your hospital stratify readmissions measures by race and/or ethnicity? Y/N

  2. 7.

    Does your hospital stratify patient and family experience measures by race and/or ethnicity? Y/N

  3. 8.

    Does your hospital stratify any other quality or safety measures by race and/or ethnicity? Y/N

Please list other measures stratified by race and/or ethnicity: ______________________

Language data collection

  1. 9.

    Does your hospital routinely gather information on language preferences of patients (apart from those of parents/guardians) for inclusion in the medical record (for example, during patient registration or intake)? Y/N

  2. 10.

    Does your hospital routinely gather information on the language preferences of parents/guardians for inclusion in the medical record (for example, during patient registration or intake)? Y/N

  3. 11.

    Does your hospital have a written policy on how to ask families about their language preferences? Y/N

  4. 12.

    Does your hospital have formal training for staff on how to ask families about their language preferences? Y/N

Language data use

  1. 13.

    Does your hospital stratify readmissions measures by language preferences?

  2. 14.

    Does your hospital stratify patient and family experience measures by language preferences?

  3. 15.

    Does your hospital stratify any other quality or safety measures by language preferences?

Please list other measures stratified by language preferences: ______________________.

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Cowden, J.D., Flores, G., Chow, T. et al. Variability in Collection and Use of Race/Ethnicity and Language Data in 93 Pediatric Hospitals. J. Racial and Ethnic Health Disparities 7, 928–936 (2020). https://doi.org/10.1007/s40615-020-00716-8

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  • DOI: https://doi.org/10.1007/s40615-020-00716-8

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