Beyond Black and White: Mapping Misclassification of Medicare Beneficiaries Race and Ethnicity

Grafova, Irina B.; Jarrín, Olga

doi:10.1177/1077558720935733

Cited by 31 publications

(23 citation statements)

References 35 publications

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“…Four of these studies also found that Asian patients were more likely to be missing information identifying their race than white patients. 24 , 30 , 33 , 36…”

Section: Resultsmentioning

confidence: 99%

The quality of social determinants data in the electronic health record: a systematic review

Cook

Sachs

Weiskopf

2021

Journal of the American Medical Informatics Association

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Objective The aim of this study was to collect and synthesize evidence regarding data quality problems encountered when working with variables related to social determinants of health (SDoH). Materials and Methods We conducted a systematic review of the literature on social determinants research and data quality and then iteratively identified themes in the literature using a content analysis process. Results The most commonly represented quality issue associated with SDoH data is plausibility (n = 31, 41%). Factors related to race and ethnicity have the largest body of literature (n = 40, 53%). The first theme, noted in 62% (n = 47) of articles, is that bias or validity issues often result from data quality problems. The most frequently identified validity issue is misclassification bias (n = 23, 30%). The second theme is that many of the articles suggest methods for mitigating the issues resulting from poor social determinants data quality. We grouped these into 5 suggestions: avoid complete case analysis, impute data, rely on multiple sources, use validated software tools, and select addresses thoughtfully. Discussion The type of data quality problem varies depending on the variable, and each problem is associated with particular forms of analytical error. Problems encountered with the quality of SDoH data are rarely distributed randomly. Data from Hispanic patients are more prone to issues with plausibility and misclassification than data from other racial/ethnic groups. Conclusion Consideration of data quality and evidence-based quality improvement methods may help prevent bias and improve the validity of research conducted with SDoH data.

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“…Four of these studies also found that Asian patients were more likely to be missing information identifying their race than white patients. 24 , 30 , 33 , 36…”

Section: Resultsmentioning

confidence: 99%

The quality of social determinants data in the electronic health record: a systematic review

Cook

Sachs

Weiskopf

2021

Journal of the American Medical Informatics Association

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“…Race was determined by EHR demographic documentation. Racial misclassification is a particular problem for many NA studies that rely on administrative data, [27][28][29] and our data may not have identified all NA COPD patients. The diagnosis of COPD exacerbation in this study was based on physician documentation and coding.…”

Section: Discussionmentioning

confidence: 88%

Native American Patients with Chronic Obstructive Pulmonary Disease Exacerbations in a Tertiary Academic Medical Center – A Pilot Study

Rhoades¹,

Chen²,

Brown³

2021

COPD

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Purpose The prevalence of chronic obstructive pulmonary disease (COPD) and comorbidities (eg diabetes and obesity) among Native American (NA) population are higher than among the general US population. However, studies of COPD in NAs are scarce. Oklahoma has the largest NA population affiliated with federally recognized tribes in the country and is an ideal location for such research. A pilot study was designed to investigate the characteristics of NA patients with COPD exacerbations in a tertiary academic medical center. Patients and Methods We conducted a retrospective exploratory study of NA adults with COPD exacerbation hospitalizations and/or emergency department visits at the University of Oklahoma Medical Center between July 2001 and June 2020. Medical records were reviewed to confirm COPD exacerbation and outcomes, including death, mechanical ventilation, intensive care unit (ICU) stay, home oxygen, and 30-day readmission. Additional collected data included socio-demographics, body mass index, diabetes, other COPD comorbidities and clinical variables. Results Of 630 encounters reviewed, 159 met the inclusion criteria, representing 91 patients. Most patients were female (64%), obese or overweight (68%), and had diabetes (42%) or hypertension (71%). Mean age was 60 years old, but women were 5 years younger than men. Among the 76 patients with COPD hospitalizations, 31 patients (41%) had an intensive care unit (ICU) stay and 19 (25%) were intubated in their last hospitalization. Among 9 patients (10%) with 30-day readmissions, 8 were female. Medicare, Indian Health Service, Tribal health service, or Medicaid were the most frequently used payment sources. Sex, diabetes, and obesity were not associated with hospital length of stay, 30-day readmission or supplemental O2 use. Conclusion Hospitalized NA COPD patients at this tertiary care center had multiple comorbidities. Many required ICU care and intubation. Larger studies of the risk and mitigating factors for COPD health outcomes in NA patients are needed.

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“…Individual-level characteristics including age, sex, race/ethnicity, insurance, comorbidities, hospital length of stay, and use of home health care during the 120 days prior to the index hospitalization were extracted from the Medicare Beneficiary Summary File (MBSF) and OASIS files [ 18 ]. To minimize the frequency of unknown/other race and misclassification error, the imputed Research Triangle Institute (RTI) race variable contained in the Medicare Beneficiary Summary File (MBSF) was augmented with the patient’s self-reported race/ethnicity from the home health care assessment (OASIS) data [ 25 , 26 ]. We used six mutually exclusive racial/ethnic categories: non-Hispanic White, Black, Hispanic, Asian American/Pacific Islander (AAPI), American Indian/Alaska Native (AIAN), and unknown/other.…”

Section: Methodsmentioning

confidence: 99%

Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity

Smith

Lin

Thomas‐Hawkins

et al. 2021

IJERPH

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Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3–7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25–1.32). Among the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97–4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

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Beyond Black and White: Mapping Misclassification of Medicare Beneficiaries Race and Ethnicity

Cited by 31 publications

References 35 publications

The quality of social determinants data in the electronic health record: a systematic review

The quality of social determinants data in the electronic health record: a systematic review

Native American Patients with Chronic Obstructive Pulmonary Disease Exacerbations in a Tertiary Academic Medical Center – A Pilot Study

Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity

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