Error Rates in Race and Ethnicity Designation Across Large Pediatric Health Systems

Leaders at three Michigan hospitals aiming to address equity issues for pediatric patients started by inspecting data key to identifying potential inequities.
 
What they learned: much of those data are inaccurate.
 
A study from the Michigan Child Health Equity Collaborative (Mi-CHEC) found substantial errors across the three health systems in racial and ethnic designations in their electronic medical records (EMR) while using parent/guardian report as the gold standard for comparison with the EMR.
 
Accuracy of these designations are important to clinical care improvement efforts yet error rates of race in electronic medical records ranged from 22% to 59% while errors in ethnicity ranged from 5% to 35%, according to the findings in JAMA Network Open.
 
The study reflects the first published data from Mi-CHEC, which comprises the state’s three largest pediatric hospitals, including U-M Health C.S. Mott Children’s Hospital, Children’s Hospital of Michigan and Corewell Health Helen DeVos Children’s Hospital.
 
“The goal of MI-CHEC is to identify inequities affecting children’s health and implement improvement strategies to address them. But if the data regarding race and ethnicity are wrong, there’s a real risk of missing some inequities and even trying to correct inequities that may not exist,” said lead author and Mi-CHEC founder Gary L. Freed, M.D., M.P.H., professor in the department of pediatrics at the U-M Medical School.
 
Reasons for the discrepancies are still being assessed, but authors point out associations between errors in designations and the evolving range and number of potential categories used by health systems for racial and ethnic attribution.
 
Options for race designation across hospitals ranged from six at one system to 49 in another while options for ethnicity ranged from two to 10.
 
“There have been significant, well-intentioned efforts over the last several years at many institutions to expand the choices for patients to designate their own race or ethnicity to promote inclusion among our patient populations,” Freed said. “However, we found that a greater number of choices may lead to greater error in the electronic medical record.”

The findings from this study were published in JAMA Network Open. It was also featured by the Department of Pediatrics.

Authors: Freed GL, Bogan B, Nicholson A, Niedbala D, Woolford S