The documents in this section were developed by the AHRQ Enhanced State Data grantees to assist stakeholders in their states and are provided as a starting point for your efforts at data improvement. You may want to revise as appropriate to fit your particular needs. Investigators from California used training and educational resources such as FAQs, staff scripts, and questionnaires to improve data collection efforts by hospital staff. Investigators from New Mexico and California developed surveys of hospital staff and patients to evaluate factors that influence and impede data collection efforts and to better understand the patient perspective in providing R/E and tribal identification information. Results obtained from R/E/L data collection can be used to inform stakeholders of their population demographics, existence of healthcare disparities, and opportunities for developing targeted interventions.

Once resources for undertaking a project to educate and train hospital staff have been secured and the project is underway, the next major steps in the process are as follows:

• Ensuring Adequate IT Infrastructure
  
• Training Frontline Data Collectors
  
• Collecting R/E/L Data from Patients
  
• Measuring the Effectiveness of Education and Training Efforts

Among the challenges facing the collection of race, ethnicity, and primary language (R/E/L) data are restrictive, inconsistent, and expensive hospital information technology (IT) systems that are not equipped to store, maintain, and effectively use such information. Hospital IT departments are major stakeholders in the collection of R/E/L information, and can play a strategic role in implementing the framework for collecting R/E/L data.

Information technology staff are in the best position to identify the infrastructure and resources required—including financial and technical constraints such as the need for hospitals to have their systems reprogrammed by their external systems vendor who may be unwilling or unable to do so, or the cost implications if vendors are allowed to charge for modifications to the existing systems in response to the new federal regulations governing the collection of R/E/L data.

IT staff are also well placed to integrate the necessary elements such as the new fields or codes into existing systems or make the case to hospital management to invest in upgraded systems that are able to capture and code the data.

In order to make the data comparable across hospitals and other healthcare entities that collect such information, information systems and software must be designed to incorporate standard R/E/L fields. Additionally, IT staff will need to ensure that if demographic data are collected using a different system from the electronic health records (EHR), that the data can be linked across systems for quality improvement purposes.

Since IT personnel are key to ensuring the reliable collection and maintenance of R/E/L data, and since they will be working closely with registration and admitting staff, care must be taken to provide IT staff with the requisite training they need as well as an understanding of the rationale and benefits for accurate collection of R/E/L data.

Hospital personnel who handle patient registration and admission are on the front lines of R/E/L data collection in hospitals, are vital to the data quality improvement effort, and require appropriate training to enable them to handle the process of collecting what many patients consider sensitive information. Training should educate admissions staff as to the correct procedures for collecting this information—including scripts that they can use when asking patients for their R/E/L information.

Admissions staff might perceive there to be barriers in requesting this information from patients. For instance, they may cite time constraints as a barrier to asking questions about patient R/E/L information during the registration process. However, a pilot study has shown that the average time to completion of open-ended questions asking patients to self-report their race/ethnicity is 37 seconds (Baker et al, Am J Public Health. 2006 March; 96(3): 532–537). Staff may also experience discomfort with asking patients about race and ethnicity, fearing that patients might feel discriminated against. These are issues that can be dealt with by training, evaluating, and retraining staff to feel comfortable with the process, and by ensuring that staff feels supported by hospital leadership in their efforts.

Training should also emphasize to staff the importance of asking each and every patient about their race, ethnicity, and what their language preference is rather than relying upon staff observation. In general, patient self-categorization of their race and ethnicity is the most accurate source of the information, and patients are more likely to select the same categories over time to describe themselves compared to staff making assumptions about the patients’ racial and ethnic background.

Why Should Hospitals Collect Patient Race, Ethnicity, and Language? (PDF file, 163 KB; HTML)

Provides explanations to admissions/registration staff on the need to update and standardize how race, ethnicity, and language preference data is collected and recorded. It outlines the reasoning behind collecting this information directly from the patients themselves, and highlights the important role that frontline staff have in recording complete, high quality data. (Developed by the California grantee)

Standardizing the Collection of Race, Ethnicity and Tribal Affiliation Data (PDF file, 2.1 MB; HTML)

Hospital onsite training presentation for admissions and registration staff on reasons their organization is standardizing R/E/L data collection, how the data will be collected, and how to address patient questions about why this change is occurring. (Developed by the New Mexico grantee)

Frequently Asked Questions about Collecting R/E/L Data (PDF file, 37 KB; HTML)

Addresses data collection, staff burden, definitions of R/E/L terms, OSHPD codes, and helpful tools. (Developed by the California grantee)

Adapting a National Curriculum to Better Collect Race and Ethnicity Data in New Mexico Hospitals (PDF file, 264 KB; HTML)

A conference poster describing a process for improving training tools for hospital staff by incorporating health behavior theories to increase efficacy. (Developed by the New Mexico grantee)

Race, Ethnicity, and Language Data Collection: Nuts and Bolts (PDF file, 180 KB; HTML)

A presentation on training staff and informing leadership about the importance of effectively collecting high quality R/E/L data that meet state requirements and can be used to improve quality in hospitals. (Developed by the California grantee)

Pre-Intervention Survey of Hospital Staff (PDF file, 95 KB; HTML)

Self-administered survey tool asking hospital staff about their own R/E/L information and their knowledge of their organization’s efforts to collect R/E/L data. (Developed by the New Mexico grantee)

Survey of Hospital Staff (PDF file, 42 KB; HTML)

Self-administered survey of hospital staff on what R/E/L data is currently collected, if there are guidelines for doing so, and what barriers to collection exist; and asks for other contacts at hospital that would be knowledgeable about the topics in the survey. (Developed by the New Mexico grantee)

Survey on Race and Ethnicity Data Collection (PDF file, 83 KB; HTML)

Survey script for asking hospital managers for their own R/E/L information, what R/E/L data is currently collected, if there are guidelines for doing so, what barriers to collection exist, if there have been recent changes in administrative leadership, and if individual hospital report cards seem useful. (Developed by the New Mexico grantee)

Recommended Staff Script for Collecting R/E and Tribal Affiliation Data (PDF file, 82 KB; HTML)

Script designed to help admissions and registration staff ask patients for their R/E/L information. (Developed by the New Mexico grantee)

FAQs about Collecting Patient Race, Ethnicity, and Language—For Hospital Staff (PDF file, 129 KB; HTML)

A document that provides answers to questions that patients frequently ask during the registration process. (Developed by the California grantee)

Script for Hospital Staff to Explain to Patients Why They are Asking for R/E/L Information (PDF file, 160 KB; HTML)

For use by hospital admissions/registration staff when asking patients to provide their R/E/L information. Patients may be uncomfortable when asked about these topics and the script allows staff to explain to the patient the importance and purpose of collecting this information and to ensure them of its confidentiality. (Developed by the California grantee)

Patient Demographics Questionnaire–Staff Administered (PDF file, 28 KB; HTML)

This survey tool is for use by admissions and registration staff for collecting R/E/L information from patients in person or over the phone. The document contains two pages of instructions to the data collector, a one-page introductory script explaining why the R/E/L information is being collected, followed by a one-page questionnaire. (Developed by the California grantee)

Patient Demographics Questionnaire–Self Administered (PDF file, 27 KB; HTML)

The target audience of this tool is patients and their families. The document contains a two-page questionnaire that the patient fills out, preceded by two pages of instructions for data collectors. (Developed by the California grantee)

FAQs about the Collection of Patient Race, Ethnicity, and Language—For Patients (PDF file, 122 KB; HTML)

Provides answers to questions that are frequently asked by patients during the admission/registration process. Hospitals can attach this list to registration forms, offer it as a handout to patients, or post it in the waiting area. (Developed by the California grantee)

Help Us Know Our Patients Better (PDF file, 95 KB; HTML)

A one-page flyer to educate patients about the importance of R/E/L data collection and to clarify the vocabulary for race, ethnicity, and tribal classification. (Developed by the New Mexico grantee)

Immediate Post-Intervention Survey for Hospital Staff (PDF file, 80 KB; HTML)

Self-administered survey tool asking hospital staff about their own R/E/L information and their attitudes toward collecting R/E/L data at their hospital. (Developed by the New Mexico grantee)

Post-Intervention Follow-up Survey for Hospital Staff (PDF file, 384 KB; HTML)

Self-administered survey tool asking hospital staff about their own R/E/L information, their knowledge of their organization’s efforts to collect R/E/L data, barriers to data collection, and their attitudes toward collecting R/E/L data at their hospital. (Developed by the New Mexico grantee)

Patient Post-Hospitalization Telephone Survey (PDF file, 33 KB; HTML)

Survey document for calling people hospitalized in the past year to ask for their R/E/L information and evaluate their experiences related to R/E/L data collection during their hospital stay. (Developed by the New Mexico grantee)

Sample Hospital Report Card (PDF file, 133 KB; HTML)

An example of a quarterly report that evaluates and tracks an individual facility’s progress in collecting race and ethnicity data and compares patient populations represented in statewide hospital data to the geographic area served. (Developed by the New Mexico grantee)