Key strategies and concepts for aligning with updated federal and state guidelines

MSHIELD, state, and federal guidance all recommend a multiple-categories “Select all that apply” approach to asking the race/ethnicity question. The intention of these policies is to better capture people’s self-identified race/ethnicity categories but may not fully capture people who primarily identify as “multi-racial”. MSHIELD plans to develop additional best practices on data collection for this important area in the future.

While the OMB guidance does not require additional categories for “unknown” or “other”, we recommend including “prefer to self-identify” and “prefer not to answer” as best practices in patient questionnaires and MDHHS provides similar guidance. MSHIELD does not recommend including the language “unknown” or “other” in a patient-facing questionnaire, but hospital staff could enter “Unknown/Race or Ethnicity Not Asked” when they were unable to ask the patient to self-identify.

Hospitals and CQIs can continue to collect more detailed race/ethnicity information to meet the needs of their patient populations; OMB offers suggested categories for more detailed information (Figure 1). These can later be rolled up into the broad categories recommended for data coding and submission.

For more detailed race/ethnicity information that hospitals and CQIs may end up collecting, including in the “Prefer to self-describe” write-in field, MSHIELD recommends considering a cross-walk between write-in responses and the broad race and ethnicity categories above. 

Because the OMB guidelines allow for multiple selection, storage systems for the data need to include multiple fields—at least one for each of the above race/ethnicity categories and one for “Unknown” which can include refused or missing responses to patient questionnaires.