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Rama Salhi, MD, an investigator in the Department of Emergency Medicine at Massachusetts General Hospital, and an Assistant Professor of Emergency Medicine at Harvard Medical School, is the lead author of a recently published study in JAMA Network Open, Frequency of Discordant Documentation of Patient Race and Ethnicity.

What was the question you set out to answer with this study?

Patient demographic data, including race and ethnicity, get collected at many clinical visits, including in the emergency department. This information goes into the medical records and then into larger datasets, and is ultimately used to detect and address gaps in healthcare and outcomes.

However, little is known about how these recording patterns may change over time and, as a result, how our use of these data is impacted. Using a large state dataset, we found that the error rate may be higher than previously realized – especially for children. Since it’s impossible to know what the “truth” is in a retrospective study on demographics, we were interested in how race/ethnicity data entries changed over time. Specifically, we set out to quantify how frequently patients have changes in their documented race/ethnicity when they present to the emergency department on multiple visits.

What Methods or Approach Did You Use?

This was a retrospective study using the Michigan Emergency Department Improvement Collaborative registry, a statewide network of 42 hospitals from 10 health systems, from December 1, 2018, to November 30, 2021. The study included over 500,000 patients with more than one ED visit in the study period.

What Did You Find?

We found significant discordance between ED visits for documentation of race and ethnicity for adults at 1.7% and children at 7%.

Although we were unable to determine the specific process by which hospitals assign race and ethnicity to their patients, the findings suggest variability and inconsistency in the approach.

What are the Implications?

These findings suggest that the data we use to identify disparities, make resource allocation decisions, or make policy/reimbursement changes may require some quality improvement. These inaccuracies may lead to persistent or even widened disparities.

Paper cited:

Salhi, R. A., Macy, M. L., Samuels-Kalow, M. E., Hogikyan, M., & Kocher, K. E. (2024). Frequency of Discordant Documentation of Patient Race and Ethnicity. JAMA network open, 7(3), e240549. https://doi.org/10.1001/jamanetworkopen.2024.0549

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.