Abstract
Background/Aims National health priorities include reduction of health disparities among racial/ethnic minorities. The cultural and linguistic diversity in the Palo Alto Medical Foundation (PAMF) service areas presented a compelling case for improving the collection of race, ethnicity, ancestry and primary language (R/E/A/L) data to accurately assess and address health disparities across all racial/ethnic groups.
Methods In May 2008, the PAMF began collecting patient self-reported R/E/A/L information, following the format of the U.S. 2000 and 2010 Census. The paper questionnaire (available in 9 languages) collected information on race (including Asian subcategories), Hispanic Origin (including Hispanic subcategories), ancestry (free text), preferred spoken language (free text), and interpreter services (Y or N). This information was subsequently entered in the patient’s electronic health record by clinic staff.
Results Across PAMF, there are over 650,000 active patients with approximately 2.3 million patient visits per year. To date, of the active PAMF patients who have self-reported R/E/A/L information (65% of all active patients), 54% self-identify as Non-Hispanic White/Caucasian, 30% self-identify as one of the 6 major Asian racial/ethnic groups (12% Asian Indian, 11% Chinese, 3% Filipino, 1% each of Japanese, Korean and Vietnamese), 2% self-identify as Black/African American and approximately 10% self-identify as Hispanic/Latino. Most patients are willing to provide the requested information (> 90%). The accuracy of transfer of data from the paper questionnaire to the EHR across questions was high (92–97%).
Discussion Patient R/E/A/L data has been used to identify racial/ethnic differences in cardiovascular disease and type 2 diabetes prevalence rates. These research findings have allowed PAMF to implement several culturally competent clinical programs, with the goal of improving healthcare for diverse populations. Our experience demonstrates the feasibility and benefits of collecting R/E/A/L data in an ambulatory health care setting to assess and address health disparities.
