Improving Race & Ethnicity to Advance Health Equity.pptx

1. IMPROVING RACE AND ETHNICITY
DATA QUALITY
TO ADVANCE HEALTH EQUITY

2. C O N F I D E N T I A L
TRAINING OBJECTIVES
1. Understand the importance of data collection.
2. Learn foundational terminology.
3. Understand current and future state.
4. Know why and how to ask, and how to document in Epic.
5. Become familiar with addressing patient/caregiver concerns.

3. WHY WE COLLECT RACE AND ETHNICITY
INFORMATION

4. C O N F I D E N T I A L
WHY | WE ASK BECAUSE WE CARE
Accurate, self-reported race and ethnicity allows us to:
Identify differences in
individual care
Examine disparities
within populations
Provide needed
resources to patients

5. C O N F I D E N T I A L
WHY | WE ASK BECAUSE WE CARE

6. C O N F I D E N T I A L
WHY | POLICY AND BEHAVIOR STANDARDS
• The University of Utah (“University”) is committed
to providing and fostering an environment that is
safe and free from prohibited Discrimination
• The University of Utah does not discriminate
against individuals on the basis of race, ethnicity,
color, religion, national origin, age, disability, sex,
sexual orientation, gender, gender identity,
gender expression, pregnancy, pregnancy-related
conditions, genetic information, or protected
veteran status (“protected class”)……
NON-DISCRIMINATION POLICY PROMISE STANDARDS
• I am kind to others and value individual
differences including culture, age, religion, and
gender.
• I offer assistance to those who may need help or
find someone who can.
• I always act in the best interest of patients,
students, employees, leaders, and our
organization.

7. GETTING STARTED

8. C O N F I D E N T I A L
VOCAB PRIMER
race and ethnicity describe a group with shared characteristics or culture.
RACE &
ETHINCITY
COMBINED
a structural construct that describes a group of people that share certain distinct physical attributes
such as skin color or facial features.
RACE
a structural construct that defines a group of people who share cultural expression, background,
and identification.
ETHINCITY

9. CURRENT AND FUTURE STATE

10. C O N F I D E N T I A L
CURRENT AND FUTURE STATE
2 questions to collect race and ethnicity 1 combined question to collect race and ethnicity
6 race options
Over 90 race and ethnicity options
2 ethnicity options
FUTURE STATE
CURRENT STATE

11. C O N F I D E N T I A L
CURRENT STATE: RACE & ETHNICITY

12. C O N F I D E N T I A L
FUTURE STATE
Asian
Asian American
Asian Indian
Bhutanese
Burmese
Cambodian
Chinese
Filipino/a
Hmong
India Indian
Japanese
Karen
Kareni
Korean
Laotian
Mongolian
Nepalese
Pakistani
Thai
Tibetan
Vietnamese
Other Asian
Black
African
African American
Burundi
Caribbean/West Indian
Congolese
Ethiopian
Ghanaian
Haitian
Jamaican
Kenyan
Nigerian
Somali
South Sudanese
Sudanese
Other Black
Hispanic/Latino/a/x
Argentinean
Caribbean/West Indian
Colombian
Cuban
Dominican
Ecuadorian
Guatemalan
Honduran
Mexican American
Mexican, Chicano/a
Peruvian
Puerto Rican
Salvadoran
Spanish/Spaniard
Venezuelan
Other Hispanic/Latino/a/x
Native Hawaiian/Pacific
Islander
Fijian
Micronesian/Marshallese/Pala
uan (COFA communities)
Native Hawaiian
Pohnpeian
Saipanese
Samoan
Tahitian
Tongan
Other Pacific Islander
White
Afghan
Bosnian
Dutch
English
French
German
Italian
Irish
Polish
Russian
Scandinavian/Nordic
Scottish
Slavic
Ukrainian
White American
White Australian/New
Zealander
Other White
Other Sections
Choose not to disclose
Accurate identification not
listed
User did not ask (Staff use)
Unable to obtain (Staff use)
Middle Eastern or North
African (MENA)
Egyptian
Iranian
Iraqi
Israeli
Kurdish
Lebanese
Moroccan
Syrian
Other Middle Eastern or
North African
American Indian/Alaska
Native
Diné (Navajo)
Newe (Goshute)
Newe (Shoshone)
Nuche (Ute Tribe)
Nuwuvi (Paiute)
So-So-Goi (Shoshone)
Other American Indian/Alaska
Native

13. C O N F I D E N T I A L
NEW RAE DATA COLLECTION REQUIREMENTS
• New patients will be asked to enter demographic data using updated race and ethnicity information via
MyChart/PRS/Care Navigation
• Return patients will be prompted to update race and ethnicity if listed as an old value
• Patients will be asked to confirm their race and ethnicity every 6 months as part of the existing patient verification
process

14. C O N F I D E N T I A L
MYCHART DATA COLLECTION
• Patients can enter and update their
race and ethnicity in MyChart.
• If a patient declines to answer
during registration, you can offer
to have them self-disclose in
MyChart.
MYCHART
MYCHART
MOBILE

15. HOW AND WHEN TO ASK

16. C O N F I D E N T I A L
RACE & ETHNICITY PILOT | RESULTS
333 31
4
12
380 total patients
Single RAE
Multiple RAE
Accurate Identication
Not Listed
Choose Not to
Disclouse
Focused on the list and asking the
question in a one-question format
(did not test Epic functionality)
Conducted September 6th –
September 30th
Pilot Locations
 Redwood Health Center
 Madsen Geriatrics
 Guest Communications (Call
center)
 Madsen Internal Medicine
 Cardiovascular Center

17. RACE & ETHNICITY PILOT | FINDINGS
What to expect
• Fewer patients pushed back than expected;
many patients were surprised and happy
• Staff had less discomfort after trying it
How to prepare
• Be prepared with suggested verbiage
• Having the physical list helps with in-person
registration
• Tone and confidence helps when asking
• Understand the why before you start
“I loved it! There is so much more
research that can be down with the
more specific information that we
are gathering with this.”
- Pilot participant at Redwood Primary Care
“Everyone I spoke to was happy
that they were able to give both
race and ethnicity.”
- Pilot participant in Guest Communications
“I really love this, because as being
Hispanic and also looking very
European; it reflects where I come
from and who I am, in a sense.”
- Pilot participant in Guest Communications

18. C O N F I D E N T I A L
Race & Ethnicity
HOW TO ASK
Using the new combined race and ethnicity format, ask the patient about their race and ethnicity and inform
them that more than one can be selected. You can use the following scripting examples below:
“To make sure all patients get the best care
possible, we would like you to tell us about
your race and ethnicity your answers are
confidential.
May I ask you for your race and
ethnicity?“
"I understand. I'll record that you don't wish to share.
You can enter this information on your own in MyChart
if you wish”
“How would you describe your race and ethnicity?
Please select as many as apply”
“What race and ethnicity do you identify
with? Please select as many as apply”
OR
Yes
No

19. C O N F I D E N T I A L
EPIC DATA ENTRY
Record the answer or answers in
the new combined formatted
field.
Race and Ethnicity
A
A

20. C O N F I D E N T I A L
EPIC DATA ENTRY
The patient may choose one or multiple choices.
Clicking the magnifying glass will open up the newly
expanded list of over 90 RAE choices.
• If the patient chooses not to
share their information, you
may use the option of “choose
not to disclose.”
• Confirmation Warning: “Race
has been left blank or Unable
to Obtain or User did not
ask. Please update value in the
demographics form”
A
B
B You can also type in a specific RAE choice for easier
navigation.
A

21. LET’S PRACTICE

22. C O N F I D E N T I A L
ADDRESSING PATIENT/CAREGIVER CONCERNS
You may encounter patients who feel uncomfortable providing their racial and
ethnic information.
• It is important to be sympathetic to their perspective.
• Remind patients that their answers are confidential.
• Do not push them to answer if they are uncomfortable.

23. C O N F I D E N T I A L
ADDRESSING PATIENT/CAREGIVER CONCERNS
Patient situation Staff response What to record
Seeking opinion from
staff
Remember that you are not trained to make assumptions.
What you can say: "I'm trained not to make assumptions. It's really
up to you as self-identification is the most accurate way to collect
this data.”
Whatever option the patient ultimately
selects
Confused Remind them there is not a wrong answer.
What you can say: “Where is your family from”
"It's really up to you. Race is often thought of as physical attributes,
where ethnicity is connected to cultural backgrounds.”
Record the most fitting option for the
situation. * Their specific race and ethnicity *
Choose not to disclose * Unable to obtain
(Patient not available or details not known) *
Accurate identification not listed
Upset Be understanding and validate their feeling.
What you can say: “It is perfectly alright if you do not want to answer
the question. However, this information does help our hospital
provide better care. Regardless of whether you answer these
questions, we will provide you care.”
Choose not to disclose
Concerned Inform the patient that knowing this information can help reduce
health risks and disparities and improve quality of care
What you can say: “Although we are all individual people, our racial
and ethnic backgrounds may place us at differing risks for some
diseases. We can work to reduce these risks by making sure that
everyone gets high quality health care.”
Record the most fitting option for the
situation. * Their specific race and ethnicity *
Choose not to disclose * Unable to obtain
(Patient not available or details not known) *
Accurate identification not listed

24. LET’S PRACTICE | WHEN THE PATIENT WANTS YOUR OPINION
Can’t you tell by looking
at me?
I was born in Nigeria, but I’ve
really lived here all my life.
What should I say?
What do you think I am?
I could be wrong, so it’s
better to let you tell me.
That is really up to you. You
can use any term you like. It
is fine to say that you are
Nigerian. You can also
choose to select more than
one.
I can review the options
with you, it is best that you
select this information for
yourself.
Show or tell the patient some of the options and remind them it is their choice. You don’t make assumptions.

25. LET’S PRACTICE | WHEN THE PATIENT IS CONFUSED
Who will you give this
information to?
I don’t know what race and
ethnicity are.
Why are you asking this?
This information will be
stored in your medical
record. The staff providing
your care will be able to see
this information. We do not
share any medical records
without getting the patients
permission.
Race and ethnicity describe
a group of shared
characteristics or culture. .
Race is often thought of as
physical attributes, where
ethnicity is connected to
cultural backgrounds.
We collect this information
to help our care teams
understand more about
your racial and ethnic
background. Knowing this,
can help us get a better
idea of health risks and can
influence your health care
plans.
Knowing this information can help reduce health risks and disparities and improve the quality of care.

26. LET’S PRACTICE | WHEN THE PATIENT IS UPSET
Why do you care? We’re all
human beings?
That is none of your business.
Are you trying to find out if
I’m a US citizen?
We ask to make sure we
provide the best equitable
care possible.
Studies have shown that a
patient's race and ethnicity
aids in the best treatment
plan.
No problem, I can put down
that you don’t want to
answer.
No, definitely not. Patient
confidentiality is protected
by law, and we do not share
this information with
anyone.
Do not push them to answer if they are uncomfortable. Offer the patient the option to self disclose through MyChart.

27. WRAP UP
Remember:
• We ask because we care.
• Responding to each other with
kindness is essential. In times when
people of color or otherwise
underrepresented might feel
increased racial or minority trauma,
consider an extra pause.
• Be confident when asking this
question. Your tone matters.
• Be prepared to answer why we ask.
• Lean on your team when you
encounter unique experience.
Thank you for asking,
your list now has my
personal identity to
report.
I feel seen in your list.
I now understand why
this information is
important for my health.
Thank you for explaining
why you ask.
I don’t have to select
other!

28. Our ability to reach unity in
diversity will be the beauty and the
test of our civilization.
- Mahatma Gandhi

29. C O N F I D E N T I A L
RACE AND ETHNICITY PROJECT RESOURCES
∙ Race and Ethnicity Pulse Page
∙ U Health List of Race and Ethnicity Options
∙ Epic Playground Log In information
∙ More Than "Some Other Race": Improving Race and Ethnicity Data Quality to Advance Health
Equity
∙ New American Resources Pulse Page
∙ More Than Just a Label: Refugee to New American

30. Thank you