Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1014 — Transition to the New Race/Ethnicity Data Collection Standards in the Department of Veterans Affairs

Author List:
Sohn MW (MCHSPR)
Zhang H (MCHSPR)
Arnold N (VIReC)
Stroupe K (MCHSPR)
Taylor B (CCDOR)
Wilt T (CCDOR)
Hynes D (VIReC)

Objectives:
Patient race in the Department of Veterans Affairs (VA) healthcare administrative files was previously recorded based on a VA administrative or clinical employee’s observation (observer-recorded). Since 2003, the VA started to collect race data based on patient self-report. We investigated the accuracy of the VA administrative observer-recorded race data compared with self-reported data in the VA administrative files.

Methods:
All unique users of VA healthcare services with self-reported race/ethnicity data in fiscal year (FY) 2004 were compared with their old observer-recorded race/ethnicity data from FY 1997 – 2002 (N = 988,277).

Results:
In FY 2004, only about 39% of all VA healthcare users reported race values other than “Unknown” or “Declined.” Females reported race at a lower rate than males (27% vs. 40%; p < 0.001). Over 95% of observer-recorded data agreed with self-reported data. Compared with the patient self-reported data, the observer-recorded White and Black races were accurate for 98% (kappa = 0.89) and 94% (kappa = 0.93) of individuals, respectively. Accuracy of observer-recorded races was much worse for other minority groups with kappa coefficients ranging between 0.38 for American Indian or Alaskan Natives and 0.78 for Hispanic Whites. When observer-recorded race values were reclassified into Black and non-Black groups, they agreed with the self-reported data for 98% of all individuals (kappa = 0.93).

Implications:
Self-reported race is poorly populated in the VA administrative files. For overall VHA users, the agreement between observer-recorded race data and new patient self-reported race data was excellent and these results compare favorably with the race data in the Medicare Enrollment Database. However, observer-recorded race data for non-Black minority groups including Hispanics, Asians, and Native Americans should be reported and interpreted with caution.

Impacts:
The VA needs to develop a plan to improve the completeness of its race/ethnicity reporting. This research shows that the observer-recorded data may be used to complement the self-identified data, especially for non-Hispanic Whites and Blacks.