Disparities in Health Care: Issues for National Reporting

Slide presentation from the AHRQ 2009 conference.

On September 19, 2009, Kalahn Taylor-Clark made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (460 KB) (Plugin Software Help).

Slide 1

Disparities in Health Care: Issues for National Reporting

Kalahn Taylor-Clark, PhD, MPH
Research Director, Racial/Ethnic Health Care Equity Initiative
The Brookings Institution

AHRQ 2009 Annual Conference


Slide 2


  • Integrating equity in the data environment
  • Overview of key IOM recommendations
  • High Value Health Care Project/Equity Initiative
  • Considerations for implementation of recommendations


Slide 3

Advancing Health Care Equity: Integrating the Data Environment


Slide 4

Institute of Medicine (IOM) Report
Key Recommendations
Subcommittee on Standardized Collection of Race/Ethnicity Data for
Healthcare Quality Improvement
August 31, 2009

Entities should collect data on granular ethnicity and elicit race responses consistent with current OMB standards

Collect data on preferred language and level of English proficiency

Develop standards to support data exchange of race/ethnicity/language across multiple entities

Utilize indirect estimation where self-reported data are unavailable


Slide 5

Racial/ethnic Health Care Equity Initiative Motivation and Goals

  • Consistent body of research demonstrates significant variation in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable.


  • Health care organizations should collect, report, and monitor patient-care data to build a foundation for solutions to racial/ethnic disparities in care
  • Increase equity in care by increasing accountability and monitoring and improving clinical care quality


  • Despite continued attention to data concerns, inadequate information continues to limit the analyses of health care-related disparities and their outcomes.

Goals of Racial/ethnic Health Care Equity Initiative
Promulgate best practices for collecting, monitoring, and disclosure of race/ethnicity data to promote equity in care across all groups.


Slide 6

Massachusetts Quality and Cost Council Uniform Reporting System for Health Care Claims Data Sets 129 CMR 2.00


Race Code
Code Description
R1 American Indian/Alaska Native
R2 Asian
R3 Black/African American
R4 Native Hawaiian or other Pacific Islander
R5 White
R9 Other Race
UNKNOW Unknown/not specified
Ethnicity Code
Code Description
2182-4 Cuban
2184-0 Dominican
2148-5 Mexican, Mexican American, Chicano
2180-8 Puerto Rican
2161-8 Salvadoran
2155-0 Central American (not otherwise specified)
2165-9 South American (not otherwise specified)
2060-2 African
2058-6 African American
AMERCN American
2028-9 Asian
2029-7 Asian Indian
BRAZIL Brazilian
2033-9 Cambodian
CVERDN Cape Verdean
CARIBI Caribbean Island2034-7 Chinese
2169-1 Columbian
2108-9 European
2036-2 Filipino
2157-6 Guatemalan
2071-9 Haitian
2158-4 Honduran
2039-6 Japanese
2040-4 Korean
2041-2 Laotian
2118-8 Middle Eastern
PORTUG Portuguese
RUSSIA Russian
EASTEU Eastern European
2047-9 Vietnamese
OTHER Other Ethnicity
UNKNOW Unknown/not specified



Slide 7

Suggested Categories for Collecting RACE/LATINO ETHNICITY IDENTIFIER

  • * Check All That Apply
  • American Indian/Alaska Native
  • Asian
  • Black
  • Hispanic/Latino/White
  • Hispanic/Latino/Black
  • Hispanic/Latino/Other
  • Native Hawaiian/Pacific Islander
  • White
  • Declined

* If organization does not have space to collect more than one race/Latino ethnicity category, health plan may submit a waiver to include “multiracial” as a category.


Slide 8


Top Ten Spoken Languages in
Massachusetts by Census  
Top Ten Most Frequently
Encountered by MA Acute Care
Top Ten Languages FLNE 
Spanish Spanish Spanish 
Portuguese Portuguese Portuguese 
French Russian Chinese 
Italian Chinese Haitian Creole 
Chinese Haitian Creole Vietnamese 
French Creole Cape Verdean Khmer 
Russian Vietnamese Cape Verdean 
Vietnamese Arabic Russian 
Greek  American Sign Language (ASL) Arabic 
Polish Albanian Korean 

*U.S. Census Report: http://www.fairus.org/site/PageNavigator/facts/state_data_MA
**FLNE - a bi-annual publication of MDPH with language data collected by the Massachusetts Department of Education for students whose primary language is not English.



Slide 9

Advancing Health Care Equity: Integrating the Data Environment


Slide 10

Considerations for
Developing Guidelines

  • Consumer preferences. What are consumers' concerns about direct data collection by plans? What are consumer preferences for reporting race/ethnicity (e.g. available response categories)? To what messages about data collection activities/benefits do various consumer populations respond? What information on health care equity do consumers want to know?
  • Modes of data collection. What are organizations' capabilities for acquiring directly collected or third party source data? What are cost effective modes of data collection for organizations?
  • Use of data. How will organizations and State analyze data? What will (goals of) interventions be (i.e. quality advancement v. disparities reduction)? Who will be involved?


Slide 11

Considerations for
Developing Requirements

  • Developing standard categories and thresholds for reporting
  • Acquiring third party source data
    • Submission protocols/file formats
  • Incorporating indirectly estimated data
    • Submission protocols/File formats
    • Incorporating directly collected and indirectly estimated data


Slide 12

Thank You!!

  • ktclark@brookings.edu
Current as of December 2009
Internet Citation: Disparities in Health Care: Issues for National Reporting. December 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2009/taylor-clark2/index.html