Transcript Guidance on the Collection of Race and Ethnicity by

Guidance on the
Collection of Race and
Ethnicity Data
by Ambulance Services
Bruce Cohen, Sylvia Hobbs, James West, Georgia Simpson-May
Massachusetts Department of Public Health
Purpose of this Information
• Provide instructions on how to collect
race and ethnicity data in the
prehospital setting
• Provide tools for responding to
questions patients may have and to
reduce patient and EMT discomfort
• Explain why race and ethnicity data
are required to meet State and
National requirements
Question 1, Hispanic Ethnicity
1. Are you Hispanic/Latino/Spanish?
❑ Yes
❑ No
If a patient asks
“What is meant by Hispanic,
Latino or Spanish?”
EMT Response: “A person is Hispanic, Latino or Spanish if he
or she considers themselves to be of Hispanic or Latino
heritage. Usually, but not always people who trace their
heritage or family’s heritage to Spain or a country in Latin
American can think of themselves as Hispanic.”
Record Patient’s Yes or No Response
If the response is some, partly, half, or a little,
please enter Yes.
If a patient declines, enter Not Reporting.
If a patient asks
“Are you trying to find out if I
am a US Citizen?”
EMT Response: “No, definitely not. Also,
the confidentiality of all patient information
if protected by law.”
Record Patient’s Yes or No Response
If the response is some, partly, half, or a little,
please enter Yes.
If a patient declines, enter Not Reporting.
MATRIS (NEMSIS) Hispanic Ethnicity Data
ETHNICITY
E06_13
Data Format [combo] single-choice
National Element
Definition
The patient's ethnicity as defined by the OMB (US Office of Management and Budget)
XSD Data Type
xs:integer
XSD Domain (Simple Type)
Ethnicity
Multiple Entry Configuration
No
Accepts Null
Yes
Required in XSD
Yes
Field Values
-25
Not Applicable
-15
Not Reporting
-20
Not Recorded
690
Hispanic or Latino
695
Not Hispanic or Latino
Uses
●
A component of the EMS Medical Record: Patient Care Report
●
Allows data to be sorted based on ethnicity as required from a state and federal government reporting perspective
●
Allows data to describe the ethnicity of the EMS patient population
Data Collector
●
EMS personnel or electronically through linkage with a pre-existing Patient Care Report or hospital database
Other Associated Elements
E00
Common Null Values
E01_01
Patient Care Report Number
E06_01 Last Name
References in NHTSA Version 1
Essential
Element
43
Race/Ethnicity
References to Other Databases
● NFIRS 5.0
EMS Module; Title: Ethnicity; Check-Box: Hispanic = Yes or No
Question 2, Race
2. What is your race? (select all that apply)
❑ American Indian/Alaska Native
❑ Asian
❑ Black
❑ Native Hawaiian or other Pacific Islander
❑ White
❑ Other
❑ Unknown/not reporting
If a patient declines
or does not know,
enter Not Reporting.
If a patient responds:
“We’re all human beings”
EMT Response: “We collect this
information to make sure everyone
gets the best possible care.”
If a patient declines
or does not know,
enter Not Reporting.
MATRIS (NEMSIS) Race Data
RACE
E06_12
Data Format [combo] single-choice
National Element
Definition
The patient's race as defined by the OMB (US Office of Management and Budget)
XSD Data Type
xs:integer
XSD Domain (Simple Type)
Race
Multiple Entry Configuration
No
Accepts Null Yes
Required in XSD
Yes
Field Values
-25
Not Applicable -20
Not Recorded
-15
Not Reporting
660
American Indian or Alaska Native
665
Asian
670
Black or African American
675
Native Hawaiian or Other Pacific Islander
680
White
685
Other Race
Uses
●
A component of the EMS Medical Record: Patient Care Report
●
Allows data to be sorted based on race as required from a state and federal government reporting perspective
●
Allows data to describe the race of the EMS patient population
Data Collector
●
EMS personnel or electronically through linkage with a pre-existing Patient Care Report or hospital database
Other Associated Elements
E00
Common Null Values
E01_01
Patient Care Report Number
E06_01 Last Name
References in NHTSA Version 1
Essential
Element
43
Race/Ethnicity
References to Other Databases
● NFIRS 5.0
EMS Module; Title: Race; Pick-List: White = 1, Black = 2, American Indian, Eskimo, Aleut = 3, Asian = 4,
Other, Multi-racial = 0, Race Undetermined = U
If a patient asks “Why?”
EMT Response: There are new state
requirements that all ambulance
services in Massachusetts collect this
information.
This information will only be used to
guarantee that all patients receive the
highest quality of care and to ensure
the best services possible.
If a patient wants more information…
Some patients will want a more detailed explanation about why the data are
being collected before responding. In such cases, the EMT should explain
that the State will use the data to ensure that we are providing quality
care and serving a diverse population. We are collecting this information
from all patients. This will help us to see differences in health among
different populations. We can reduce those differences by reaching out to
people and offering additional services.
Although we are required to ask, respondents are NOT required to provide
answers. If a patient elects not to answer, the EMT should select the
“Not Reporting” box.
EMTs should NOT guess or select the category he/she believes best
describes the patient.
If a patient asks about Privacy
EMT Response: “Your privacy is protected.”
Who accesses the information:
•
Hospital Registration personnel
•
EMS and Hospital Care Providers
•
EMS Quality Control Personnel
Who does not access the information:
• Immigration
• The general public
If the patient refuses
EMT Response: “I understand that these
questions may be a little sensitive. We are
required to ask all patients. This
information will be kept private and will only
be used to improve the healthcare we
provide to all.”
If the patient still refuses
EMT Response: “That is okay. You have the
right to not answer these questions.”
Record Patient’s
Response as Not
Reporting
Why does the State want
Race and Ethnicity Data?
Collecting race and
ethnicity data will help us
better address
disparities and improve
the quality of service
delivery. Health
Disparities are both a
National and State
Problem.
Added Value
OF RACE
•
•
•
civil rights infringement:
monitors discrimination,
equality of opportunity
and treatment, and
indirectly, institutional
racism
more routinely collected
limited capacity to use
alternative data
collection processes:
(observation, informant,
surname)
OF ETHNICITY
• more consistently
understood
• less likely to change over
time, less context
dependent
• more useful for program
targeting and
development
• measure of cultural
practices
• improved sensitivity to
linguistic needs
What are Health Disparities?
Health disparities are differences in health outcomes and their determinants
between segments of the population, as defined by social, demographic,
environmental, and geographic attributes. Health inequalities, which is
sometimes used interchangeably with the term health disparities, is more
often used in the scientific and economic literature to refer to summary
measures of population health associated with individual- or group-specific
attributes (e.g., income, education, or race/ethnicity). Health inequities are a
subset of health inequalities that are modifiable, associated with social
disadvantage, and considered ethically unfair. Health disparities, inequalities,
and inequities are important indicators of community health and provide
information for decision making and intervention implementation to reduce
preventable morbidity and mortality. Except in the next section of this
report that describes selected health inequalities, this report uses the term
health disparities as it is defined in U.S. federal laws and commonly used in
the U.S. public health literature to refer to gaps in health between segments
of the population.
Source: CDC MMWR Rationale for Regular Reporting on Health Disparities and Inequalities--United
States, January 14, 2011 / 60(01);3-10
What is the Public Health Rationale for
Measuring Health Disparities?
Increasingly, the research, policy, and public health practice literature report
substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as
well as persistence of these disparities among segments of the population. In 2007, the
CDC’s Healthy People 2010 Midcourse Review revealed progress on certain objectives
but less than adequate progress toward eliminating health disparities for the majority
of objectives among segments of the U.S. population, defined by race/ethnicity, sex,
education, income, geographic location, and disability status.
During 1980--2000, the U.S. population became older and more ethnically diverse, and
during 1992--2005, household income inequality increased. Although the combined
effects of changes in the age structure, racial/ethnic diversity, and income inequality
on health disparities are difficult to assess, the nation is likely to continue experiencing
substantial racial/ethnic and socioeconomic health disparities, even though overall
health outcomes measured by Healthy People 2010 objectives are improving for the
nation. Because vulnerable populations are more likely than others to be affected
adversely by economic recession, the recent downturn in the global economy might
worsen health disparities throughout the United States if the coverage and
effectiveness of safety-net and targeted programs do not keep pace with needs .
Source: CDC MMWR Rationale for Regular Reporting on Health Disparities and Inequalities--United
States, January 14, 2011 / 60(01);3-10
Evidence of Health Disparities in
Massachusetts
• The cancer death rate for men was 46% higher
than the rate for women
• Blacks had the highest premature mortality rate,
1.5 times the rate of whites
• The death rate for those with less education was
almost 3 times higher than the rate for those with
more education
• Springfield, Lowell, Fall River, Taunton, Worcester,
and New Bedford had the highest premature
mortality rates
Source: Massachusetts Deaths 2007, Massachusetts Department of Public Health Bureau of Health Information, Statistics,
Research, and Evaluation, Division of Research and Epidemiology, Registry of Vital Records and Statistics, April 2009
Premature Mortality Rates (PMR) by
Community Health Network Area
(CHNA) Massachusetts: 2007
Massachusetts PMR= 295.4
Source: Massachusetts
Deaths 2007,
Massachusetts Department
of Public Health Bureau of
Health Information,
Statistics, Research, and
Evaluation, Division of
Research and Epidemiology,
Registry of Vital Records
and Statistics, April 2009
12
11
10
2
13
9
16 14
15
1
17
3
7
8
19
18
21
4
20
5
6
22
23
2007 PMR by CHNA
24
Significantly higher than state rate
Not significantly different from state rate
Significantly lower than state rate
CHNA PMR
1. Community Health Network of Berkshire = 331.0
2. Upper Valley Health Web-Franklin County = 303.5
3. Partnership for Health in Hampshire County = 319.1
4. The Community Health Connection = 384.3
5. Community Health Network of Southern Worcester County = 335.9
6. Community Partners for Health = 290.2
7. Community Health Network of Greater Metro West = 238.6
8. Community Wellness Coalition = 355.6
9. Fitchburg/Gardner Community Health Network = 322.6
10. Greater Lowell Community Health Network = 350.9
11. Greater Lawrence Community Health Network = 281.9
12. Greater Haverhill Community Health Network = 331.3
13. Community Health Network North = 267.4
25
26
14. North Shore Community Health Network = 316.5
15. Greater Woburn/Concord/Littleton Community Health Network = 192.0
16. North Suburban Health Alliance = 285.6
17. Greater Cambridge/Somerville Community Health Network = 232.7
18. West Suburban Health Network = 210.6
19. Alliance for Community Health = 358.4
20. Blue Hills Community Health Alliance = 298.4
21. Hampshire County Partnership = 351.5
22. Greater Brockton Community Health Network = 366.6
23. South Shore Community Partners in Prevention = 284.9
24. Greater Attleboro-Taunton Health & Education Response = 354
25. Partners for a Healthier Community = 378.9
26. Greater New Bedford Health & Human Services Coalition = 343.5
27. Cape Cod & Islands Community Health Network = 295.9
Rates are per 100,000 persons under 75 years of age, age-adjusted to the 2000 US standard population and are calculated using MDPH
population
estimates
foryears
2005,ofwhich
are the most
available at the sub-state level by age groups.
Rates per 100,000
population
under 75
age; age-adjusted
to up-to-date
the 2000 USestimates
standard population.
27
Mortality Rates by Education and
Race/Ethnicity, Adults 25-64 Years1
Massachusetts: 2007
Deaths per 100,000
800
600
High School or Less
13+ Education
727.3
*
533.7
*
467.7
*
400
358.5
231.0
200
181.0
0
Whites
Blacks
* Statistically higher than those with 13+ yrs of education (p<0..05)
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population
Hispanics
1Uses
2000 Population Estimates
Source: Massachusetts Deaths 2007, Massachusetts Department of Public Health Bureau of Health Information, Statistics, Research, and
Evaluation, Division of Research and Epidemiology, Registry of Vital Records and Statistics, April 2009
Premature Mortality Rates
by Race and Hispanic Ethnicity
Massachusetts: 2007
Deaths per 100,000
600
428.3
400
*
293.5
277.4
295.4
Hispanics
Total
200
141.3
*
0
Whites
Blacks
Asians
(*) Statistically different from State (p ≤.05)
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population persons ages 0-74
Source: Massachusetts Deaths 2007, Massachusetts Department of Public Health Bureau of Health Information, Statistics, Research, and
Evaluation, Division of Research and Epidemiology, Registry of Vital Records and Statistics, April 2009
Diabetes Mortality Rates
by Race and Ethnicity
Massachusetts: 2007
Deaths per 100,000
40
37.4
*
28.2 *
30
20
16.5
15.5
9.9
10
*
0
Whites
N=1,041
Blacks
N=96
Asians
N=15
Hispanics
N=62
Total
N=1,216
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population * Statistically different than state rate (p<0.05)
Source: Massachusetts Deaths 2007, Massachusetts Department of Public Health Bureau of Health Information, Statistics, Research, and
Evaluation, Division of Research and Epidemiology, Registry of Vital Records and Statistics, April 2009
Mortality Rates for Causes
Amenable to Health Care by Race/Ethnicity
Massachusetts: 2000 and 2007
2000
2007
160
Deaths per 100,000
142.9
122.9
120
105.4
103.6
80.5
80.8 **
82.1 **
80
64.5
53.1
40.6
40
0
Whites
Blacks
Asians
Hispanics
Total
** Statistically lower than 2000 rate (p<0.05)
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population persons ages 0-74
Source: Massachusetts Deaths 2007, Massachusetts Department of Public Health Bureau of Health Information, Statistics, Research, and
Evaluation, Division of Research and Epidemiology, Registry of Vital Records and Statistics, April 2009
Concluding Thoughts
• Collecting race and ethnicity data will help us better
address disparities and improve the quality of service
delivery
• For additional information on health disparities, see:
– Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care available for free online at:
http://www.nap.edu/openbook.php?isbn=030908265X
– CDC Health Disparities and Inequalities Report —
United States, 2011 available for free online at:
http://www.cdc.gov/mmwr/pdf/other/su6001.pdf
Remember: EMTs should NOT guess or select the category he/she
believes best describes the patient.