AHA Disparities Toolkit - Frequently Asked Questions

  1. What are health care disparities?

    The word disparity can be defined as "the condition or fact of being unequal." Synonyms for disparity include inequality, unlikeness, and difference. Health care disparities can be delineated by describing differences in quality of and access to health care that lead to disparities in health outcomes and may be responsive to improvements in health care.
  2. Why is data collection of patients' race, ethnicity, and primary language important?

    Data currently available on patients' race, ethnicity, and primary language are quite limited or are inaccurate. However, these data are critical to documenting the nature of disparities in health care and developing strategies to eliminate disparities and improve quality of care.
  3. What is this Toolkit?

    This Toolkit is an easy-to-use resource for health care organizations to implement a systematic method of collecting race, ethnicity, and primary language data.
  4. What is the Toolkit designed to do?

    The Toolkit is designed to answer questions about race, ethnicity, and primary language data collection. It provides the answers to the "how to" questions and addresses concerns (legal, privacy, how to ask patients, how to address concerns) about data collection.
  5. How do I use the Toolkit?

    The Toolkit is setup to be user-friendly. The table of contents provides an outline of the type of information available on the toolkit. When you click on a topic area in the table of contents, you will be given a list of the resources available (PowerPoint presentations, categories to use, survey instruments, etc.). The toolkit is designed to guide you through each step.
  6. How do I know if I need to implement this type of tool in my hospital?

    Given the changing demographics of many communities, we recommend that all hospitals and health care organizations implement a standard, systematic method of collecting race, ethnicity, and primary language data. In addition, many health care organizations need to collect these data for federal or state reporting purposes. In the near future, accreditation standards for the collection of these data may be established.
  7. How do we address patients'/family members' concerns such as, "I have been coming here for years, don't you have that information already?"

    You can use the following response or a modification of it:

    "We may have the information already, but in some instances we do not. We want to make sure that we have the correct information for everyone so we can ensure that everyone is getting the best quality of care regardless of his/her race/ethnicity."
  8. Our system does not allow for splitting race and ethnicity as recommended by the Office of Management and Budget (OMB) 1997 revisions. How can we capture and report both these components?

    Hospitals may use one question format with ethnicity included in race if this meets their patient populations' needs. However, the race question must be asked. Hospitals may list race/ethnicity combinations as follows. (Also please go to How To Ask the Questions section of the Toolkit for details.)

    Hispanic/Latino-Black or African American
  9. We already captured race/ethnicity using the OMB categories, but we have added other options in our registration screens. Do we have to change these to match OMB?

    It is fine to capture additional information or to add more granular categories.
  10. How do we report individuals who want to identify more than one race/ethnicity? Our registration system allows us to only select one category.

    You can add a category for "some other race" or, if your systems allow you to capture more than one category, record both.
  11. Does the Joint Commission on Accreditation of Healthcare Organizations currently have standards for collecting race, ethnicity, and primary language data?

    The Joint Commission does not currently have a standard for race/ethnicity data collection, but it did issue a new standard in January 2006 requiring the collection of primary language information from patients.
  12. Is it okay to first pilot test race/ethnicity/language data collection in one or two units?

    Yes, it is acceptable and recommended that you pilot your new data collection system. You may want to consider pilot testing in both inpatient and outpatient settings.
  13. When is the best time to start communicating these changes to the community and our patient population?

    As soon as possible. You can use your hospital newsletter, community meetings, e-mail, and other venues at your disposal. You may also want to develop an informational pamphlet (in conjunction with your community relations department) that registration staff can hand out to patients.
  14. Should we ask patients for their race/ethnicity/primary language each time they come to the hospital?

    If your hospital's patient registration screen can be flagged for each patient to show that the race/ethnicity/language information was captured after the training and introduction of your new system, then you do not have to ask these questions every time. However, if you do not maintain a database (e.g., this information is purged every three months) or if your system does not allow for flagging, you may need to ask patients each time they come the hospital. We recommend that you develop a system that enables you to capture the information only once with periodic updates (e.g., every two years).
  15. What should we do if patients "refuse" or "decline" to answer the race/ethnicity questions?

    It is best to flag these patients and NOT ask again. Record these as "declined." You do not want to offend patients or push the issue. Based on our experience, the percentage of refusals is very small.
  16. Should the script for asking race/ethnicity/language questions be in paper or electronic format?

    This decision is up to each hospital. It is easier for staff if the script is on the patient registration screen, but some hospitals have indicated that there is not enough room on their screens to accommodate this option. When the script cannot be placed directly on the screen, it is best to have laminated cards, with the script typed in large bold-faced font, at each registration station.
  17. Is it okay to record race/ethnicity by observation when it is obvious to the staff and especially if the person has been coming to the hospital for years?

    No. All information on race/ethnicity/language needs to be captured through self-report of the patient or his/her caregiver. Otherwise the person is recorded as either "declined" or "unavailable" (see definitions for specifications).