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Open Access Research article

Responses of Massachusetts hospitals to a state mandate to collect race, ethnicity and language data from patients: a qualitative study

Selena Jorgensen1, Ruth Thorlby12, Robin M Weinick3 and John Z Ayanian14*

Author Affiliations

1 Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

2 Nuffield Trust, London, UK

3 RAND Corporation, Arlington, VA, USA

4 Division of General Medicine, Brigham and Women's Hospital, Boston, MA, USA

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BMC Health Services Research 2010, 10:352  doi:10.1186/1472-6963-10-352

Published: 31 December 2010



A Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients' race, ethnicity and preferred language using standardized methodology based on self-reported information from patients. This study assessed implementation of the regulation and its impact on the use of race and ethnicity data in performance monitoring and quality improvement within hospitals.


Thematic analysis of semi-structured interviews with executives from a representative sample of 28 Massachusetts hospitals in 2009.


The number of hospitals using race, ethnicity and language data internally beyond refining interpreter services increased substantially from 11 to 21 after the regulation. Thirteen of these hospitals were utilizing patient race and ethnicity data to identify disparities in quality performance measures for a variety of clinical processes and outcomes, while 16 had developed patient services and community outreach programs based on findings from these data. Commonly reported barriers to data utilization include small numbers within categories, insufficient resources, information system requirements, and lack of direction from the state.


The responses of Massachusetts hospitals to this new state regulation indicate that requiring the collection of race, ethnicity and language data can be an effective method to promote performance monitoring and quality improvement, thereby setting the stage for federal standards and incentive programs to eliminate racial and ethnic disparities in the quality of health care.