REAL data can be an effective tool for improving delivery of care.
Many hospitals do not systematically collect REAL (race, ethnicity and language) data. Understanding this aspect of patient demographics can be extremely helpful in improving delivery of care. It can also help hospitals raise patient satisfaction levels and capture a larger market share.
REAL data can demonstrate that differences exist in the quality of care among different racial or ethnic groups. It is helpful for leaders to be mindful of these disparities, which are present throughout health care and can be found in almost every setting. Because the hospital is often the point of entry for many people into the health care system, gaps in hospital care and in the community can be identified and addressed by this data.
Hospital executives can play a key role in acquiring demographic data, recognizing the gaps in care, then putting the data to good use. By doing so, care in hospitals and entire communities can be more effective and safe for all patients. Mindfulness of this issue can also position a hospital as a center of quality.
For REAL data to become useful, it must first be collected in a standardized format. The hospital executive can make an impact on quality by insisting on high-quality demographic data. High-quality data is critical to making the business case for improvement, effectively targeting needed resources and creating a plan to address the local health care community.
Appropriate data collection and analysis can help hospitals track population trends and forecast emerging changes. One example is an increase in the Spanish-speaking population. It would, of course, be helpful to offer hospital materials in Spanish and to provide translators or bilingual providers who could enhance the patient experience during a hospital stay.
Improving quality depends on accurate demographic data to help target the necessary interventions. In order to start making the business case for collecting REAL data, there are three key questions executives can ask:
Executives will find that these questions are often not easy to answer. The best intentions may give way to the limitations of current IT systems or staff members' hesitation to ask pointed questions of patients. However, there are multiple resources to train and educate staff on collecting demographic data for quality improvement. There are also cost-effective ways to collect this standardized REAL data while complying with privacy regulations.
The Institute of Medicine recently recommended the Health Research & Educational Trust Disparities Toolkit as a key resource in starting hospitals on standardizing their data collection and on using the data to make improvements. The toolkit provides ongoing training, teaching front-line staff how to interact with patients on this issue and how to meaningfully implement the toolkit. Hospital executives are invited to be full partners in this process.
Once executives make the commitment to collect demographic data, there are many uses for the information. Much depends on the interpretation of the data. For every situation of perceived differences in quality, a solution will present itself differently.
For example, a hospital might determine that among their acute myocardial infarction patients, 30-day readmissions are higher for one ethnic group than for another group after accounting for all other personal characteristics. The hospital might then further determine that these patients do not have good access to primary care services outside the hospital. The hospital may also find that these patients typically rate their satisfaction lower than that of other patients. This may suggest that there are aspects of the hospital encounter that disproportionately affects those patients.
These are important findings for the hospital. They give executives actionable items to address. They can remove barriers within the hospital to create a more patient-centered experience for these individuals. This might include patient education sessions before discharge. It might also include a training program to help employees learn how to be more culturally sensitive to the needs of a given population. This may improve patient satisfaction scores. The hospital may also determine that it needs to engage the broader health care community to identify appropriate sites of primary care to improve continuity of care for this population.
Organizations such as HRET are a resource for hospitals ready to make a genuine effort to collect data and measure organizationwide outcomes. Measuring demographics—REAL data in particular—is yet another tool in an arsenal to combat factors that may adversely impact the bottom line and, more importantly, impede the delivery of high-quality health care services.
Adaeze Akamigbo, Ph.D., M.P.P., is a senior researcher at the Health Research & Educational Trust.
This article first appeared in the on February 16, 2010 in HHN Magazine online site.