Presented To Admitting/Registration Staff

1. Nuts and Bolts of Collecting Race, Ethnicity, and Primary Language Information From Patients Presented To Admitting/Registration Staff INSERT YOUR NAME INSERT NAME OF YOUR ORGANIZATION INSERT DATE Insert your Logo © 2007 by the Health Research and Educational Trust

2. Today’s Objectives • Review the purpose of the data collection • Review current patient registration screens • Review changes that will be made to the registration screens • Review Patient Response Matrix © 2007 by the Health Research and Educational Trust

3. Purpose of This Initiative • We are implementing a systematic method of collecting data on race, ethnicity, and primary language directly from patients or their caregivers. • The purpose of collecting this information is to ensure that all patients receive high-quality care. [Note: If targeting specific population groups, insert more info here.] • Our experience will help inform hospitals across the country on improving quality of care for all populations. © 2007 by the Health Research and Educational Trust

4. Admitting/Registration Role • Admitting/Registration is key to collecting this data: • Consistently • Accurately • Professionally • Completely • The new system for data collection will be implemented _____(specify all inpatient, ED admissions, outpatient clinics, etc…) © 2007 by the Health Research and Educational Trust

5. Race DefinitionsOMB • American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. • Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. • Black or African American: A person having origins in any of the black racial groups of Africa. • Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. *OMB-Mod: This symbol indicates a modification we have made to the OMB recommendations © 2007 by the Health Research and Educational Trust

6. Race Definitions • White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. • Multiracial: A person having more than one or a combination of the above origins. *OMB-Mod • Declined: A person who is unwilling to choose/provide a race category or cannot identify him/herself with one of the listed races. *OMB-Mod • Unavailable: Select this category if the patient is unable to physically respond, there is no available family member or caregiver to respond for the patient, or if for any reason, the demographic portion of the medical record cannot be completed. Hospital systems may call this field “Unknown,” “Unable to complete,” or “Other.” *OMB-Mod *OMB-Mod: This symbol indicates a modification we have made to the OMB recommendations. © 2007 by the Health Research and Educational Trust

7. Ethnicity DefinitionsOMB • Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. • Non-Hispanic or Latino: Patient is not of Hispanic or Latino ethnicity. • Declined: A person who is unwilling to provide an answer to the question of Hispanic or Latino ethnicity. *OMB-Mod • Unavailable: Select this category if the patient is unable to physically respond, there is no available family member or caregiver to respond for the patient, or if for any reason, the demographic portion of the medical record cannot be completed. Hospital systems may call this field “Unknown”, “Unable to Complete,” or “Other.” *OMB-Mod *OMB-Mod: This symbol indicates a modification we have made to the OMB recommendations. © 2007 by the Health Research and Educational Trust

8. Ethnicity Screen • Now I would like you to tell me your race and ethnic background. We use this information to review the treatment patients receive and make sure everyone gets the highest quality of care. • First, do you consider yourself Hispanic/Latino? • Yes • No • Declined • Unavailable © 2007 by the Health Research and Educational Trust

9. Race Screen Which category best describes your race? • American Indian/Alaska Native • Asian • Black/African American • Native Hawaiian/Other Pacific Islander • White • Multiracial • Declined (This is a flag indicating that the individual did not want to answer this question—do not ask again during the same or subsequent visit.) • Unavailable (This is a flag indicating that the person could not answer the question. May ask the person again.) © 2007 by the Health Research and Educational Trust

10. Using OMB (modified) Categories Without Splitting Race/Ethnicity -African American/Black -Asian -Caucasian/White -Hispanic/Latino/White -Hispanic/Latino/Black -Hispanic/Latino/Declined -Native American -Native Hawaiian/Pacific Islander -Multiracial -Declined -Unavailable/Unknown © 2007 by the Health Research and Educational Trust

11. Primary Language Screen • What language do you feel most comfortable speaking with your doctor or nurse (patient’s primary language)? • Provide a list of options. See next slide for examples. Provide language list from the census (available in the Toolkit section Collecting the Data—The Nuts and Bolts/Which Categories to Use/Language Categories) or modify to meet the needs of the communities you serve. © 2007 by the Health Research and Educational Trust

12. New Table : Primary Language

13. English Proficiency Screen (optional) How would you rate your ability to speak and understand English? • Excellent • Good • Fair • Poor • Not at all • Declined • Unavailable The next slide provides a sample screen. © 2007 by the Health Research and Educational Trust

14. New Table: English Proficiency

15. Addressing Concerns from Patients • General rule of thumb: If a person does not want to answer these questions, move on. Do not force the issue. Simply record “Declined.” • In some instances, people may have questions or may be confused. The following slides provide a sample of questions and responses. These are not meant to be exhaustive. • You are the experts—modify as needed. © 2007 by the Health Research and Educational Trust

16. Handling the Responses from Patients: Basic Guidelines • Use common sense. • Decide whether you will provide a list of categories (either Census or OMB) or whether you will let patients self-report based on their own descriptions. • Allow patients to respond and use as much of their own description as possible. • Respect their descriptions (or choices if providing categories). • Avoid words that might be considered confrontational. © 2007 by the Health Research and Educational Trust

17. Handling the Responses from Patients: Matrix • We realize that patients might be concerned and might feel uncomfortable. • They will have questions and comments. • We want you to feel comfortable answering any questions patients ask. • The Patient Response Matrix is based on actual patient answers to the race/ethnicity questions. • The matrix is intended to be used as a tool to help you respond in the best possible manner. • Again, the best course of action is to use common sense, a nonconfrontational approach, and to take care not to push the issue if it is clear that the patient does not want to respond to the question. © 2007 by the Health Research and Educational Trust

18. Patient Response Matrix - Routine

19. Patients Returning

20. Tougher Questions These generally indicate DECLINED code.

21. Tougher Questions (cont’d)

22. Provide contact information of point person for any questions or concerns that may come up. What if the patient presents a race/ethnicity that’s not on the table? • Code as “unknown or unable to answer” or add as a text response so you can track this information. • Staff should flag this (e.g., record this information)—if this happens frequently, it may indicate a new category needs to be added to the coding scheme.