By Eleanor Boudreau
http://stream.publicbroadcasting.net/production/mp3/wkno/local-wkno-880022.mp3
Memphis, TN – "No more eye-balling the patient They appear to be black, they look white,' and we're just going and giving people races."
Rebecca Newsom is giving a presentation to North Methodist's registration staff. Dressed in a red suit she sits at the front of the room and faces the five women she is training. Behind her slides project onto a white board. The hospital is now having patients fill out a form identifying their race, and it's the registration staff who have to hand out that form, and record the answers in the hospital's computer.
Methodist North is participating in a Robert Wood Johnson Foundation study examining racial disparity in cardiac care. Heart disease is the number one killer in the U.S., and African-Americans are 30 percent more likely to die of it than whites.
Methodist North will record data on the race and treatment of its heart patients, and send a report to Washington D.C. every month for a year.
The study includes eight hospitals across the country. All eight have data broken down by race, but none of that initial data can be used because it was taken without using the new form, and it was taken without ever asking patients what race they were, some of it over the phone.
"We don't know how accurate that is," said Paula Jacobs who was sitting in on Newsom's training. Jacobs is the project leader at Methodist North for The Equity Quality Improvement Collaborative. "One of the collaborative participants was saying their model for collecting the data was going by accent," Jacobs said.
Thus eradicating disparity in health care starts by having patients self-declare their race. It starts not with a bang, but with the hum of Newsom's projector.
The ethnicity and race categories on the form come from the Federal Office of Management and Budget.
First the form will ask about ethnicity. The choices are Hispanic or Latino, or not Hispanic or Latino.
Next the form will ask about race. The choices are: Black, White, Asian, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander. Five categories to describe all the world's people. It's hardly comprehensive, as Paula Jacobs pointed out, when she suggested a rewording of the form:
"Maybe after you say, 'Which selection best describes your race,' a statement saying, 'If biracial please select the one you most identify with.'"
Newsom typed the changes.
"Is biracial hyphenated?" Newsom said.
Racial disparities in health outcomes are pervasive and systemic in the U.S. They exist for all the leading causes of death, and for all measures of quality and access to care.
Still, no one knows exactly why disparities exist, and health care professionals tend to balk at the idea that they treat patients unequally.
The hope is that the self-reflection brought on by the study will bring self-awareness, and then a fix for whatever problems exist.
That approach has worked for Methodist North in the past. For example, one measure of good cardiac care is that if a patient is going to have a balloon inserted to get blood-flow to their heart, that should happen within 90 minutes of the patient's arrival at the hospital. At one point Methodist North looked at the quality of its cardiac care and found out it wasn't hitting this mark. It wasn't even close. So the hospital took action.
"Our door-to-balloon time we've decreased from over four hours to under 90 minutes," Jacobs said. "These quality initiatives that are the product of a lot of research do save lives."
Methodist North wants this latest research project to reduce racial disparity. Still, what the hospital finds out about the disparities within its wall might be surprising. According the hospital's initial data, white patients have a higher readmission rate at Methodist North than black patients. That figure was the opposite for all the other hospitals in the Robert Wood Johnson Foundation Study.
As of now, the reason is still a mystery.
"Don't know the answers yet. But check back with me later, and maybe I will," said Jacobs.