Demographic data: Reducing disparities starts with a question

By asking patients to provide information on race, ethnicity and language, physicians can help ensure that all are getting the treatment they need.

Posted July 4, 2011.

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The first step to take in ending health care disparities is proving to be the hardest: Physician practices asking patients for their demographic information.

A report by the Commission to End Health Care Disparities, whose members include the American Medical Association, stresses the importance of individual practices compiling racial, ethnic and language data on their patients. It is a small but important task in ensuring that all get the equal quality care physicians strive to give.

The commission's report outlines many reasons why practices haven't collected such data.

There are worries that asking will violate civil rights laws, and a general discomfort by patients and practice staff about bringing up the subject of race. There is the feeling that a patient is a patient, and should be treated the same way no matter what race or ethnicity that patient may be.

The biggest reason, according to the report, is that practices just haven't seen any value to collecting the information.

But it is well worth asking patients for that information -- making the physician practice better in the quality of care it delivers, and perhaps improving its bottom line. By collecting demographic data on their patients, practices not only can improve themselves but also do their part to improve the health care system.

The point of collecting the data is not, as some might wonder, to have patients of different races and ethnicities treated and viewed differently. The point is so a practice can have a clearer snapshot of its patients and what care they are (and aren't) getting. In turn, practices can treat everyone equally. Advances in electronic medical records are making it easier -- though more has to be done to make it easy -- to stratify and analyze demographic and quality data.

No practice would have enough data to reach general conclusions about the quality of care given to each population. However, practices could break down the data to see if any clinically meaningful small trends are emerging.

For example, say a practice had only 25 Hispanic patients. If the data report that only six had received a flu shot (the national vaccination rate is 40%), a practice could reach out to its patients to try to improve the vaccination rate. The data may point out why the low rate occurred in the first place.

The demographic knowledge also could be valuable in any program that pays physicians based on quality. As the report notes, the more data collected, the more practices can adjust for practice mix, making their performance assessment more valid.

And it could be valuable for discovering if there are demographic changes happening in the practice's area that might not be obvious at first glance, thus giving the practice a chance for new growth opportunities.

Asking about demographics is not a civil rights violation, and steps can be taken to ease any discomfort in bringing up the subject. The commission's report recommends collecting the data when a patient arrives for his or her first visit (or the first visit after instituting the policy of collecting demographic data).

The practice can include the question on the same form as other personal information being collected. A script can help, stating that the question is being asked so the practice can provide quality care to everyone -- and that answering the question is voluntary.

The commission is working on a disparities tool kit similar to one designed for hospitals by the Health Education and Research Trust as a way to make the process smoother for practices.

A practice can't solve the care disparities problem all by itself. But progress starts with a few routine questions. The insight gained can create opportunities to provide better care to patients at that practice and contribute to more equal care to patients overall.

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External links

"Collecting and using race, ethnicity and language data in ambulatory settings," Commission to End Health Care Disparities (link)

Health Education and Research Trust Disparities Toolkit (link)

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