Variability in emergency demographic data and clinical outcomes - Modified Project Summary/Abstract Section Utilization of race/ethnicity data is near-universal in the conduct of medical research and assessment of health care disparities. Despite the importance of patient race/ethnicity in administrative data, the reliability of its measurement has increasingly been called into question. When compared to self-report, Medicare enrollment data accurately identified only 36% of Hispanic patients, 43% of American Indian/Alaska Native patients, and 63% of Asian American/Pacific Islander patients. These data errors result in inaccurate disease measurements, in this case, underestimating diabetes prevalence by 59%, 5%, and 23%, respectively. Such inaccuracies lead to missed detection of disparities, misdirection of interventions, and, ultimately, increased disease burden in these communities. The emergency department is a critical access point to healthcare, yet the validity and reliability of data collection in the ED is not known. Estimates from my preliminary work suggest within-person variations in race/ethnicity documentation as high as 40%. Though some amount of change over time is expected due to evolutions in social definitions and self-identification, the excess variation introduced by measurement errors hinders our ability to assess differences in clinical care delivery and outcomes, leaving us unable to intervene to improve clinical care and clinical outcomes. Given the ED’s key role in healthcare access and the resultant importance of accurate race/ethnicity data collection in this setting, strategies addressing the described data quality concerns in the context of challenges unique to the ED (e.g., high acuity and rapid evaluation) are critical. However, the limited existing guidance does not address ED-specific issues. Our specific aims are: 1) To identify factors associated with variability in race/ethnicity documentation and determine the impact of that variability on measurement clinical outcomes, 2) To develop a novel demographic data collection strategy for race/ethnicity collection, and 3) To pilot dissemination and evaluate effectiveness of our novel data collection strategy in the ED. Dr. Rama Salhi is an extremely promising emergency physician and clinician-researcher who, with the guidance of her mentorship team, is ideally suited to address this gap. During the period of support, she will pursue graduate-level didactic instruction in several disciplines, including advanced quantitative methods, survey methods, and intervention development and evaluation. The proposal includes a detailed education plan with training that will be essential for the successful completion of this research and for her career development. This career development award will lay the groundwork for Dr. Salhi to become an independent investigator and national leader in emergency medicine by leveraging systems-based approaches.
