Same patient. Different visit. Different race and ethnicity?

Statewide study shows variation in emergency department data that form the basis for efforts to identify and address health care disparities

2:00 PM

Author | Kara Gavin

computer
Credit: Justine Ross and Jacob Dwyer, Michigan Medicine

For decades, the national effort to find and fight inequity in American health care has relied on vast amounts of anonymous medical record data from tens of millions of people. 

And since many of those inequities are between groups of people from different racial and ethnic backgrounds, health related data on these characteristics is especially important to collect accurately and consistently. 

But a new study shows this doesn’t always happen

In all, 1.7% of adults and 7% of children who sought emergency care at least twice at the same Michigan hospital or health system had a different race or ethnicity marked in their patient records on different visits. 

For nearly 26% of adult patients who were registered as being Black and of non-Hispanic origin at their first visit, and 39% of those who were registered as being part of a catch-all category of “other” race and ethnicity at their first visit, all had a different race or ethnicity recorded at their second emergency visit to the same hospital or health system. 

Among children, those recorded as being white, multiracial or other on their first visit had another race or ethnicity recorded during their second emergency visit, with 32%, 18% and 23% experiencing this difference respectively. 

The findings suggests that hospitals and health systems need to do more to standardize practices for collecting race and ethnicity data in their emergency departments. What gets marked in a patient’s record in the emergency department might not get reexamined as they receive care during a hospitalization or at post-emergency visits. In some cases, the emergency department visit may be the only kind of care disadvantaged people receive. 

The study looked at data from more than half a million people who had two or more emergency visits at 42 hospitals from late 2018 to late 2021. It’s published in JAMA Network Open by a team from Harvard University, the University of Michigan and Northwestern University, and based on data from a registry maintained by the Michigan Emergency Department Improvement Collaborative.

Keith Kocher, M.D., M.P.H., who leads the collaborative and is senior author of the new study, says it suggests that “the current race and ethnicity data in electronic health record systems has important limitations, especially when influencing administrative decisions, clinical processes, research, or for countless other purposes.” 

Kocher, an emergency medicine physician and researcher at Michigan Medicine and the University of Michigan Institute for Healthcare Policy and Innovation, worked with first author Rama Salhi, M.D., M.H.S., M.Sc., who trained at IHPI’s National Clinician Scholars Program before moving to Harvard and Massachusetts General Hospital.

In an accompanying editorial, a team of experts on health care disparities research note that “high-quality data are needed to appropriately measure and address pervasive racial and ethnic health disparities with data-driven policies that advance health equity.”

The commentary notes that multiple entities are working toward this goal, including guiding principles laid out by the National Committee on Quality Assurance, and a health equity framework laid out by the federal Centers for Medicare and Medicaid Services.  

Additional authors: In addition to Kocher and Salhi, the study’s authors include Michelle L. Macy, M.D., M.S. of Northwestern, Margaret E. Samuels-Kalow, M.D., M.Phil., M.S.H.P. of Harvard; and Megan Hogikyan Norris, M.P.H., of U-M. 

Funding: The Michigan Emergency Department Improvement Collaborative is funded by Blue Cross Blue Shield of Michigan and is one of the Collaborative Quality Initiatives under the Value Partnerships program.

Citations: Frequency of Discordant Documentation of Patient Race and Ethnicity, JAMA Network Open, doi:10.1001/jamanetworkopen.2024.0549

Editorial: Race and Ethnicity Data in Electronic Health Records—Striving for Clarity, JAMA Network Open, doi:10.1001/jamanetworkopen.2024.0522

Sign up for Health Lab newsletters today. Get medical tips from top experts and learn about new scientific discoveries every week by subscribing to Health Lab’s two newsletters, Health & Wellness and Research & Innovation.

Sign up for the Health Lab Podcast: Add us on SpotifyApple Podcasts or wherever you get you listen to your favorite shows.


More Articles About: emergency departments Emergency Medicine Emergency & Trauma Care Race and Ethnicity Race Health Care Delivery, Policy and Economics Health Care Quality
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of health care news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Related
Diverse health care patients lined up together
Health Lab
Striving for more equitable health care
The Healthcare Equity Consult Service addresses the concern of bias and discriminations in health care access, delivery, and experience for University of Michigan-Health.
Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories On left, a young boy in a wheelchair has his doctor standing to his left and his parent is standing to his right in a show of support. On the right side of the image, the boy is now an adult and is wondering about the cost of his care and if his questions will be answered.
Health Lab
Changing the definition of cerebral palsy
Cerebral palsy is defined as a childhood disorder, which fails to recognize adults living with the condition and the lack of care they receive once they age out of pediatric clinics.
purple gloves close up holding piece
Health Lab
Recycled pacemakers function as well as new devices, international study suggests
Recycled pacemakers can function as well as new devices, a University of Michigan-led study suggests. These used and reconditioned devices have the potential to increase access to pacemaker therapy in low- and middle-income countries, where many patients cannot afford the treatment.
floating AI-type images in red and blues and yellow on blue background
Health Lab
Racial differences in medical testing could introduce bias to AI models
Black patients are less likely than white patients to receive certain medical tests that doctors use to diagnose severe disease, impacting artificial intelligence data. But researchers have found a way to correct the bias in these data sets.
Minding Memory with a microphone and a shadow of a microphone on a blue background
Minding Memory
Can a personalized music intervention reduce behavioral disturbances in dementia?
While memory loss is generally thought of as the hallmark of dementia, behavioral and psychological symptoms of dementia like agitation, aggression, anxiety, and hallucinations are nearly universal, affecting almost all patients with advanced dementia. These behavioral disturbances are often the trigger for nursing home placement, and they can be highly distressing for both patients and their care partners. In today’s episode, Matt and Lauren speak with Dr. Ellen McCreedy, a researcher from the Brown School of Public Health who has conducted a study of personalized music intervention called Music & Memory for people living with dementia in nursing homes. Dr. McCreedy is a gerontologist and health services researcher who focuses on evaluation of non-pharmacologic interventions for managing behavioral disturbances of people living with dementia.
family of four sitting on couch in living room looking at an ipad laughing
Health Lab
Grandparents help grandkids in many ways – but the reverse may be true too
A poll shows the many ways (childcare, nutrition, major expenses) that grandparents help their grandchildren, but also suggests a link to older adults’ sense of isolation and their mental health.
man recovering on left in hospital gown in hospital room and on right with friends taking selfie in michigan gear
Health Lab
Michigan fan saved after wife recognizes stroke at football game
After a man suffered a stroke at a University of Michigan football game, his wife’s recognition of his symptoms helped him receive lifesaving treatment and make a full recovery.