2. Everyone is seen.
Everyone is welcome.
From 10 categories
to 81 categories
2 questions to 1 question
Multi-select to reflect multiple
identities
Includes top 10 countries
of origin for UUHC patients
of new American background
Map to federal reporting requirements
in Epic
How will we use these
data?
Evaluate collection,
with aim to collect from
95% of population
Evaluate for accuracy,
timeliness, completion,
and consistency
Stratify key performance
indicators (Quality,
Patient Experience, etc.)
by race and ethnicity
Answers (and leads)
the call to improve
data quality.
National
Local
3. C O N F I D E N T I A L
Why – Accurate, self-reported race and ethnicity data is necessary to create visibility of health disparities, provide
inclusive care, and improve equity of health outcomes.
What – Patients will be prompted to update their race and ethnicity using a list expanded to 81 categories.
• New patients will be asked to enter demographic data using updated race and ethnicity list via
MyChart/PRS/Care Navigation
• Return patients will be prompted to update race and ethnicity if listed previously “other” or “unknown”
• Patients will be asked to confirm every 6 months as part of existing check-in process
• If patient selects “choose not to disclose,” patient will be prompted to confirm once/year
• Includes simplified process to collect information for new Americans (patients of refugee background)
When – starting February 23, 2023
Workflow impact – Impacts to scheduling and check-in teams’ workflow; no immediate impact to clinician workflow.
Improved analysis of outcomes and experience by race and ethnicity available in the future.
PROJECT SNAPSHOT
4. C O N F I D E N T I A L
RACE & ETHNICITY: WHAT DO WE CURRENTLY COLLECT?
Race
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White
Other
Patient opts out
Unknown/Information not available
Ethnicity
Hispanic/Latino
Not Hispanic or Latino
5. C O N F I D E N T I A L
67.2
13.2
10.8
2.5
2.4 1.81.2
0.8
Race
White/Caucasian Unknown
Other Asian
Choose not to disclose Black/African American
Pacific Islander/Hawaiian American Indian/Alaskan Native
WHAT DO OUR PATIENTS REPORT?
25% PATIENT POPULATION “UNKNOWN”/ “OTHER”
70.2
13.3
13.5
3
Ethnicity
Not Hispanic/Latino Hispanic/Latino Unknown Choose not to disclose
Ambulatory patient demographics, 2019-2022, retrieved 4.3.22
Source: Decision Support, https://tableau.utah.edu/#/views/PatientDemographic/OutpatientDemographic?:iid=1
6. C O N F I D E N T I A L
“UTAH WILL CONTINUE TO DIVERSIFY”
20% PEOPLE OF COLOR IN 2019; 35% PEOPLE OF COLOR IN 2065
Figure 2. Total Population Share by Race
Source: Kem C. Gardner Policy Institute at University of Utah, https://gardner.utah.edu/first-ever-raceethnicity-projections-for-utah-reveal-that-utah-will-continue-to-diversify/; https://gardner.utah.edu/demographics/population-
projections/raceethnicity-projections/
7. C O N F I D E N T I A L
Sources: Hasnain-Wynia, R. and Baker, D.W. (2006), Obtaining Data on Patient Race, Ethnicity, and Primary Language in Health Care Organizations: Current Challenges and Proposed Solutions. Health Services Research, 41: 1501-
1518. https://doi.org/10.1111/j.1475-6773.2006.00552.x; Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine of the National Academies.
https://doi.org/10.17226/12875; Nanney, M. S., Myers, S. L., Xu, M., Kent, K., Durfee, T., & Allen, M. L. (2019). The Economic Benefits of Reducing Racial Disparities in Health: The Case of Minnesota. International Journal of
Environmental Research and Public Health, 16(5), E742. https://doi.org/10.3390/ijerph16050742
ACCURATE DATA IS NEEDED TO…
Care more effectively for
our community
“Valid and reliable data are
fundamental building
blocks for identifying
differences in care and
developing targeted
interventions to improve
the quality of care
delivered to specific
population groups.”
Reduce health disparities
”Racial and ethnic health
disparities and inequities
can only be eliminated if
high-quality information is
available by which to track
immediate problems and
the underlying social
determinants health.”
Reduce health care
expenditures
”If racial disparities in
preventable deaths were
eliminated…translates to
$1.2b to $2.9b per year in
economic savings.”
8. C O N F I D E N T I A L
A LOCAL EXAMPLE: DATA QUALITY IMPACTS OUR ABILITY
TO SERVE OUR COMMUNITY
9. C O N F I D E N T I A L
PART OF OUR STRATEGY & OPERATIONAL PLAN
WHY?
EDUCATION DISCOVERY
EQUITY,
DIVERSITY, &
INCLUSION
SERVE
COMMUNITIES
& THE REGION
ONE U
INNOVATE
CARE
ACCOUNTABLE
FOR
OUTCOMES
FOUNDATIONAL FOR SUCCESS
EQUITY,
DIVERSITY, &
INCLUSION
10. C O N F I D E N T I A L
MULTIDISCIPLINARY PROJECT TEAM
Kim Pacheco
Director, RCSS Patient Access
Sponsors
Project Team Members
Sandi Gulbransen
Chief Quality Officer
Erica Ulibarri
Program Coordinator,
Care Navigation
Anna Gallegos
Program Coordinator, RWHC
New American Support
Mikayla Schaefer
Director, Operational Project
Management Office
RyLee Curtis
Dir, Community Engagement
Theresa Johnson
Supervisor, RCSS
Mari Ransco
Sr. Dir, Pat Experience
Michael Strong, MD
Chief Medical Information Officer
Marcie Hopkins
Manager, Human-Centered
Design, Pat Exp & Accelerate
Terrell Rohm
Director, System Quality
Analytics & Technology
Abdulkhaliq Barbaar
Director, Health Equity, Diversity
and Inclusion
Travis Gregory
Sr Dir, IT Systems
Kimberly Killam
Operations Project Manager II,
OPMO
Kim Birrell
Manager, RCSS
Project Management
11. C O N F I D E N T I A L
State of Utah recommendations
Partnership with community organizations
Research with other organizations
Top countries of origins for Utah’s new Americans
Surrounding states’ requirements
Informed by indigenous tribes
Developed over 18 months, in partnership with University of Utah Health Office of Equity
Diversity and Inclusion, Eccles Health Sciences Library, subject matter experts in ITS and EDW
HOW DID OUR LIST GROW FROM 8 TO 81 CATEGORIES?
12. C O N F I D E N T I A L
NEW LIST
American Indian/Alaska Native
Diné (Navajo)
Newe (Goshute)
Newe (Shoshone)
Nuche (Ute Tribe)
Nuwuvi (Paiute)
So-So-Goi (Shoshone)
Other American Indian/Alaska Native
Asian
Asian American
Asian Indian
Bhutanese
Burmese
Cambodian
Chinese
Filipino/a
India Indian
Japanese
Karen
Kareni
Korean
Laotian
Mongolian
South East Asian
Thai
Tibetan
Vietnamese
Other Asian
Black
African
African American
Caribbean/West Indian
Congolese
Ethiopian
Jamaican
Kenyan
Nigerian
Somali
South Sudanese
Sudanese
Other Black
Hispanic/Latino/a/x
Argentinean
Caribbean/West Indian
Colombian
Guatemalan
Mexican American
Mexican, Chicano/a
Peruvian
Puerto Rican
Salvadoran
Spanish/Spaniard
Venezuelan
Other Hispanic/Latino/a/x
Pacific Islander
Chamorro
Fijian
Guamanian
Marshallese
Micronesian/Marshallese/Palauan
(COFA communities)
Native Hawaiian
Samoan
Tongan
Other Pacific Islander
White
Afghan
Bosnian
Eastern European
Iraqi
Middle Eastern/North African
Russian
Scandinavian/Nordic
Slavic
Syrian
Ukrainian
Western European
White American
White Australian/New Zealander
Other White
13. C O N F I D E N T I A L
COORDINATION
FOR RESEARCH +
REPORTING
American Indian/Alaska Native
Diné (Navajo)
Newe (Goshute)
Newe (Shoshone)
Nuche (Ute Tribe)
Nuwuvi (Paiute)
So-So-Goi (Shoshone)
Other American Indian/Alaska Native
Asian
Asian American
Asian Indian
Bhutanese
Burmese
Cambodian
Chinese
Filipino/a
Indian (India)
Japanese
Karen
Kareni
Korean
Laotian
Mongolian
South East Asian
Thai
Tibetan
Vietnamese
Other Asian
Black
African
African American
Caribbean/West Indian
Congolese
Ethiopian
Jamaican
Kenyan
Nigerian
Somali
South Sudanese
Sudanese
Other Black
Hispanic/Latino/a/x
Argentinean
Caribbean/West Indian
Colombian
Guatemalan
Mexican American
Mexican, Chicano/a
Peruvian
Puerto Rican
Salvadoran
Spanish/Spaniard
Venezuelan
Other Hispanic/Latino/a/x
Pacific Islander
Chamorro
Fijian
Guamanian
Marshallese
Micronesian/Marshallese/Palauan
(COFA communities)
Native Hawaiian
Samoan
Tongan
Other Pacific Islander
White
Afghan
Bosnian
Eastern European
Iraqi
Middle Eastern/North African
Russian
Scandinavian/Nordic
Slavic
Syrian
Ukrainian
Western European
White American
White Australian/New Zealander
Other White
Race
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White
Other
Patient opts out
Unknown/Information not available
Ethnicity
Hispanic/Latino
Not Hispanic or Latino
14. C O N F I D E N T I A L
Inclusive language is one way U Health provides culturally
responsive and sensitive care to diverse populations
New American: an individual who is new to the United States
and was previously forced to flee their home country as a
refugee. Once they are established in the United States, we
no longer refer to them as a refugee, but rather, as New
Americans
NEW AMERICAN LANGUAGE UPDATE
15. C O N F I D E N T I A L
IMPROVING AND ENHANCING COLLECTION FOR
NEW AMERICANS
Current
State
Refugee Background
FYI Flag with custom free text notes
Future
State
New American Background
Demographic yes/no with link to standard
form with required fields
16. C O N F I D E N T I A L
WHAT DOES THIS MEAN FOR ME?
Front-desk & scheduling staff
• Asking patients to self-report race
and ethnicity as part of scheduling
and check-in
• How and why we ask is important:
supportive language for asking and
receiving demographic information
• Learning and development: training
and tip sheets
Leaders
• Helping staff understand why its
important to ask
• Supporting staff if met with
aggression/abuse
Providers
• No immediate change to workflow
• Improved analysis of outcomes and
experience by race and ethnicity
available in the future
Hinweis der Redaktion
This project advances our efforts to reduce health disparities and improve health equity for our communities.
Acknowledge that talking about complex social constructs like race and ethnicity is challenging and sometimes controversial.
As leaders in a health care system, I believe we are accountable to create environments where everyone deserves equitable treatment, where everyone deserves to be included. We, as leaders in this system, are accountable to create space where there wasn’t before. This project is about ensuring everyone feels seen, acknowledged and creating visibility.
(Could be used for very short presentations, or as a summary slide at the end of a longer presentation)
We are a diverse place, and everyone needs to feel welcome here in order to feel safe. ADD IOM, National Research Council of the National Academies
(Teal bar) This project answers a national and local call to improve data quality. Groups such as the NIH, American Hospital Association, Institute for Healthcare Improvement, Association of Academic Medical Centers, and locally the Utah Hospital Association and the State of Utah have called for improvements to data quality to better address health disparities to provide affordable, equitable care. Creating a data infrastructure is one of the first steps needed to improve health equity,
(Orange bar) The race and ethnicity list will expand from 10 categories to 81 categories and will include an opportunity to multi-select. These categories were developed after extensive research and collaboration with the State of Utah, colleagues at the Eccles Health Sciences Library, the Urban Indian Center, Office of Management and Budget, Health and Human Services, the Census, Utah Department of Health, CMS, our surrounding States, and our research colleagues, multiple peer academic organizations and will include the top 10 countries of origin for new Americans (patients of immigrant and refugee background). It will also map to federal reporting requirements because of collaborative work with ITS and EDW.
(Pink bar) We will use this information in multiple ways. Initially, we will ensure that we are collecting information for at least 95% of our patients and set an accepted threshold for “unknown,” or “other.” We will evaluate our collection processes to see if we need to expand where and when we collect this information to ensure that the data is accurate, timely, complete, and consistent with our population. We will begin to stratify our key performance indicators (value roadmap metrics, quality, patient experience, etc.) by race and ethnicity.
Ultimately, we can use this data as a pathway to equitable, personalized care. Currently, we can only provide precision medicine for the largest group who we know the most about. Collecting these data supports moving towards precision medicine.
Here’s our project at a glance.
Collecting accurate, self-reported race and ethnicity data is necessary to create visibility of health disparities, provide inclusive care, and improve health equity outcomes. The self-reported piece of that statement is very important.
The process change will be that…
Mirrors US Census – Office of Management and Budget categories. Established in 1997
Used for risk adjustment in payments
Up until the last 10 years, data was mostly collected by observation
What do we currently know about how our patient population answers that question?
One third, 33% identify as something other than white or Caucasian
One quarter of our patient population identified as “unknown” or “other”. (the purple and orange slices)
This is a trend that is mirrored in national data.
Zooming out, what do we know about our state?
From the Kem C Gardner Policy Institute on campus – Utah is becoming much more diverse. The Policy Institute released a report with the headline “Utah will continue to diversify”
Underrepresented population shares of Utah are projected to increase from the current 20 percent to 35 percent by 2065 and will account for half of the state’s population growth. This is a generational shift with youth becoming ever more diverse as compared to the elderly. This demographic transformation is a result of Utah’s increasing global interconnections, principally through markets, technology, and migrations of people. We project that Utah will remain less diverse than the nation, but trend in the same direction.
Bottom line: Utah at less than 2 million was a very different place than Utah at greater than 3 million residents. Utah’s population growth has been fueled by a consistently strong natural increase and also a steady stream of new people choosing to make our state home. People move here for economic, educational, and outdoor recreational opportunities. They come from all over the nation and increasingly from international source regions. These new Utahns, and their children, continue to contribute to the cultural, linguistic, religious, ethnic, and racial diversity of our state.
CLICK
Zooming in a bit more - the % of people identifying as more than 1 race or ethnicity will grow over the next thirty years, more than other underrepresented populations - gray line on right hand chart
Highlighting 3 studies
And not knowing who a patient is has real-life consequences.
And that gap in understanding has significant meaning for our ability to have targeted interventions that matter.
Here’s one recent example --
This is a screenshot from our Covid Vaccine distribution dashboard
Here you can see on the left the number and percent of patient population who were eligible at the time for the vaccine.
Nearly 20% of our population was of unknown race or ethnicity.
As we looked for equitable distribution of Covid Vaccine distribution, we saw real success in our targeted interventions to close care gaps in the Latinx/Hispanic/Black/African African populations when compared nationally.
But you can see that for those people who we didn’t understand who they were, we were unable to close the care gap and they were less likely to receive their doses of the vaccine.
Understanding who our patients are matters for our ability to distribute health resources equitably, and affects all parts of our tripartite mission. Without data quality we cannot perform effective research or train the next generation of health care providers to deliver inclusive clinical care.
For all those reasons….
Together as One U, we serve communities and the region, advance equity, diversity, and inclusion, lead education and discovery, and innovate care accountable for outcomes.
We have made this commitment as part of our Strategy 2025 and the Hospitals and Clinics value roadmap.
On our FY22 value roadmap, we include targeting known health disparities and working to close those gaps.
We cannot close disparities in care without first understanding who the patients are.
This work has been led by multidisciplinary team representing 9 teams in the organization.
Project team has been working for ~12 months ( Started in May 2021)
Cross-function and multi-disciplinary
The group performed multiple rounds of external research, completed a white paper with recommendations, and collected patient feedback to inform collection, staff training and support, patient education.
State of Utah + top Utah New American List + Cultural considerations + surrounding states and Indigenous tribes
Research over 18 months
Team open discussions on current state and future needs
Reviewed the State of Utah’s Race and Ethnicity Additional Granularity Recommendation
Completed White paper and gap analysis, and risk/benefit analysis
Researched Additional Health Care Facilities RAE standards and data collection ( Denver- REAL Project UCSF) & Phen X Tookit
Understood new list was coming for the state.
First listed focused on additional granularity
Worked through barriers (Waiting for updated State list, our list was due before it was received, Source of truth-Census, too large, Denver, unable to validate, mapping not a good idea)
Finalized First list 3/25/22 after receiving feedback from the UHEDI Team
Clarified the meanings of our unknown type answers
State proposed updated List 4/1/22. Compared the new State list from our final list. Decision to keep the items we had above the State list.
Redrafted our list- Considerations, New American Patients, Feedback from SMEs on areas we choices to added along with other list items (such as Karen and Kareni), Affiliate and Surround state Details, Researched specific Native American tribes in Utah and surrounding states. Double checked New American Countries and accepted feedback from SME’s
Multi select?
Don’t have a multi select option.
Multiple select available to patient
Mapping on the backend from IT and EDW teams -
If anything includes Hispanic/latino value, it will go to Hispanic or Latino
University of Utah will have a multiselect
If for OMB, go to other
State of Utah + top Utah New American List + Cultural considerations + surrounding states and Indigenous tribes
Research over 18 months
Team open discussions on current state and future needs
Reviewed the State of Utah’s Race and Ethnicity Additional Granularity Recommendation
Completed White paper and gap analysis, and risk/benefit analysis
Researched Additional Health Care Facilities RAE standards and data collection ( Denver- REAL Project UCSF) & Phen X Tookit
Understood new list was coming for the state.
First listed focused on additional granularity
Worked through barriers (Waiting for updated State list, our list was due before it was received, Source of truth-Census, too large, Denver, unable to validate, mapping not a good idea)
Finalized First list 3/25/22 after receiving feedback from the UHEDI Team
Clarified the meanings of our unknown type answers
State proposed updated List 4/1/22. Compared the new State list from our final list. Decision to keep the items we had above the State list.
Redrafted our list- Considerations, New American Patients, Feedback from SMEs on areas we choices to added along with other list items (such as Karen and Kareni), Affiliate and Surround state Details, Researched specific Native American tribes in Utah and surrounding states. Double checked New American Countries and accepted feedback from SME’s
This project will also include updates to the medical record to simplify and streamline information for patients of New American background.
This is something the clinical care teams have asked for. This change keeps all of the information in the relevant spot so that the care provider can easily see the information, allowing them to better prepare, include trauma-informed strategies into their care, and connect the patient with resources. It will be part of the patient storyboard. If registrar hears certain words, they can confirm that the patient is a new American in demographics, and then that will then prompt them to fill out the new form.
Why these elements are in the screenshot (if someone asks):
DOA informs use of case management, correct forms
Country of birth – specific health conditions
Refugees are sometimes born one place and are in a camp somewhere else, can have conditions there that affect care
Initial health screening clinic is important for patients establishing care, we need to be aware of where they were screened.
Refugee/asylee/HP/SIV – different resources available based on status
Dot phrases
This change will impact a few teams very specifically, and then drive broader data analysis and focus on equity as the data begins to be collected.
