Responses of Massachusetts hospitals to a state mandate to collect race, ethnicity and language data from patients: a qualitative study

Thematic analysis of semi-structured interviews with executives from a representative sample of 28 Massachusetts hospitals in 2009.The number of hospitals using race, ethnicity and language data internally beyond refining interpreter services increased substantially from 11 to 21 after the regulation. Thirteen of these hospitals were utilizing patient race and ethnicity data to identify disparities in quality performance measures for a variety of clinical processes and outcomes, while 16 had developed patient services and community outreach programs based on findings from these data. Commonly reported barriers to data utilization include small numbers within categories, insufficient resources, information system requirements, and lack of direction from the state.The responses of Massachusetts hospitals to this new state regulation indicate that requiring the collection of race, ethnicity and language data can be an effective method to promote performance monitoring and quality improvement, thereby setting the stage for federal standards and incentive programs to eliminate racial and ethnic disparities in the quality of health care.A growing body of research has documented the pervasive nature of disparities in health outcomes for racial and ethnic minorities within the US[1-4]. The Institute of Medicine's (IOM) 2003 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, highlighted the need to transition from describing disparities to developing methods by which they can be reduced[2]. The standardized collection of data on patients' race, ethnicity, and preferred language has been widely recognized as a necessary step to improve the quality of care by developing effective interventions to reduce disparities[4-10]. In 2009 the IOM strongly recommended that health-care organizations and the federal and state governments accelerate efforts to collect these data[4].In 2006 Massachusetts adopted a novel approach to the collection of race an