Limitations in data quality were noted for children of multiple races and children of AIAN origin. The quality of racial and ethnic information in children has not been well studied. However, the results from the present study were comparable to two previous studies investigating race and ethnicity information in adults [ 14 , 15 ]. These patterns are generally consistent with the accuracy observed for racial and ethnic information in Medicare enrollment databases [ 23 ]. The present study also shows that the patterns of misclassification varied greatly between Hispanic and non-Hispanic children.
This partially explains the lower sensitivity observed in our study compared to other studies which excluded non-classified individuals from their study population [ 14 , 15 ]. Incomplete and missing information on race, ethnicity and language in databases from health care organizations has been reported by others previously [ 24 ]. The results from our study suggest that birth certificate information is not routinely used to fill missing information in administrative records, even if available as in this setting.
The second important cause of disagreement between administrative records and birth certificates was the misclassification of children whose parents had a different race i. Among children of multiple races, the vast majority of children were misclassified because only racial information of one parent - mostly maternal information - was used for classification purposes. One possible explanation for this misclassification is an often observed simplification of multiracial heritage. Multiple races are often reported as one main race [ 25 , 26 ].
Multiracial identification varies across regions and races; in particular, AIAN are less likely to report themselves as multiracial [ 26 ]. It may also be speculated that maternal presence during birth as well as later medical encounters account for this observation.
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The present study adds new information on changes in the quality of race information over the course of membership. The present study shows that the quality of information increased over time with increasing number of medical encounters, especially inpatient visits. Although the effects may differ in magnitude by organization, we can assume our results are generalizable to other integrated health care settings that update their patient's demographic data during office visits.
Our study benefited from the substantial size of a diverse population with adequate numbers of Hispanic and non-Hispanic racial and ethnic group representation to generate ample statistical power and allow valid estimates of sensitivity and PPVs. A limitation of the present study is the use of information obtained from birth certificate records as a criterion standard. After carefully reviewing the birth certificate records, previous studies have reported that birth certificate records provide relatively valid information on race and ethnicity [ 16 , 19 ]. Race and ethnicity from birth certificates are also used as standards for federal statistics such as intercensal population estimates [ 20 — 22 ].
Consequences of misclassification of racial and ethnic minorities can lead to data misinterpretation and erroneous conclusions.
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Incorrect classification of individuals of a small minority group may lead to over or underestimation of health disparities and race-related risk factors. Therefore, accurate racial and ethnic information is crucial for health care research. Results of the present study suggest that the overall quality of racial and ethnic information is relatively good for distinguishing between Hispanics and non-Hispanics, Whites, and Blacks.
Our results also show that use of health plan administrative records alone leads to frequent misclassification of minority groups and individuals of multiple races.
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Thus, linking birth certificate information to the administrative records of children can optimize the accuracy of race and ethnicity classification if this information is available. J AmMedInformAssoc. Bordowitz R, Morland K, Reich D: The use of an electronic medical record to improve documentation and treatment of obesity.
Cebul RD: Using electronic medical records to measure and improve performance. Trans Am ClinClimatolAssoc. D'Avolio LW: Electronic medical records at a crossroads: impetus for change or missed opportunity?. Dunn MJ: Benefits of electronic medical records outweigh every challenge. Stevens GD, Shi L: Effect of managed care on children's relationships with their primary care physicians: differences by race.
ArchPediatr AdolescMed. Health ServRes. J NatlCancer InstMonogr. AmJ Public Health. BMCPublic Health. J ObstetGynecolNeonatal Nurs.
Vital Health Stat 2. Edited by: State of California DoF. Health Care FinancRev. Hasnain-Wynia R, Baker DW: Obtaining data on patient race, ethnicity, and primary language in health care organizations: current challenges and proposed solutions. Assessing the Complexity of Lived Race. Am Sociol Rev. The American People: Census Edited by: Farley R, Haga J. Download references. Correspondence to Corinna Koebnick. The authors report no conflicts of interest.
The authors alone are responsible for the content and writing of the paper. Reprints and Permissions. Smith, N. Health plan administrative records versus birth certificate records: quality of race and ethnicity information in children. Download citation. Search all BMC articles Search.
Abstract Background To understand racial and ethnic disparities in health care utilization and their potential underlying causes, valid information on race and ethnicity is necessary. Methods Information on race and ethnicity of , children born between was extracted from health plan administrative records and compared to birth certificate records.
Results Misclassification of ethnicity and race in administrative records occurred in Conclusions In children, race and ethnicity information from administrative records has significant limitations in accurately identifying small minority groups. Open Peer Review reports. Background Increasing attention has been given to the research potential of information collected in electronic health records [ 1 — 3 ]. Race and ethnicity information from birth certificate records Race and ethnicity from birth certificates are often used for federal statistics, particularly for intercensal population estimates and annual statistical tabulations regarding maternal and child health [ 20 — 22 ].
Table 1 Characteristics of the study population Full size table. Figure 1. Full size image. Discussion This study utilized the most recent race and ethnicity data collected as part of the administrative records of a large, integrated health plan and compared it to information available from birth certificates.
Conclusions Results of the present study suggest that the overall quality of racial and ethnic information is relatively good for distinguishing between Hispanics and non-Hispanics, Whites, and Blacks. References 1. Article PubMed Google Scholar 2.
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