Validity of ethnicity recording in the maternity clinical administration system in NHS Lothian, Scotland Dr Fatim Lakha Mr Andrew Massie Dr Dermot Gorman.

Validity of ethnicity recording in the maternity clinical

administration system in NHS Lothian, Scotland

Dr Fatim Lakha

Mr Andrew Massie

Dr Dermot Gorman

Outline of presentation

• Background

• Aims

• Methods

• Classification

• Results

• Conclusions and next steps

Background

• Health experiences, care & management of different ethnic groups vary

• Reduction in inequalities is a priority – 2010 Equality Act (UK)– 2010 Healthcare Quality Strategy Scotland

• NHS is striving to collect routine ethnicity data in a standardised way

• The accuracy of this data recording has not been validated to date

Aims

• To evaluate the completeness & validity of ethnicity recording in the maternity administration system

• To assess if could describe use/need for interpretation services by ethnic group alone and/or in conjunction with other data

Annual completion rates of ethnicity data in the maternity clinical administration system

NHS Lothian (maternity Trak)

Year Ethnicity recording completion rate

2009 52%

2010 86%

2011 93%

2012

2013

2014 (to end Oct)

97%

97%

97%

Methods (1)

• Maternity TRAK – records self assigned ethnicity plus ‘preferred language and need for an interpreter – data collected by a midwife in early pregnancy

• National Records Scotland records for all live births in 2012 (birth certificates) – mother’s country of birth – on official registration of the birth

• The two datasets were linked

Methods (2)

• For both datasets each individual record was assigned to one of 13 classification groups

• Sensitivity, specificity, PPV and NPV calculated• Explored use/need for interpreter by ethnicity

alone and with preferred language.

Geographical classification groups

• African• Australasian• Caribbean• East Asian• Eastern Europe• European other• Middle East

• North American• South American• South Asian• UK• Other• Refusal/unknown

Results

Validity of Maternity TRAK ethnicity data

Explaining the reduced sensitivity of ethnicity to ‘country of birth’

Validity of Maternity TRAK ethnicity data

How does TRAK ethnicity match to NRS country of birth?

Can ethnicity be a guide to interpreter requirements?

Preferred language and interpreter requirement for self-reported ‘South Asians’

Preferred language and interpreter requirement for self-reported ‘Eastern

Europeans’ (n=611)

Strengths

1.High levels of completeness2.Accurate recording by staff – staff training etc has helped and mandatory now so very helpful3.able to classify individuals into 13 classification groups thus then easy to compare NRS with mat trak4.NRS registration is mandatory and the MCOB is 100%

Limitations

1.NRS data incomplete for December - This led to reduced matching and sample size.2.Too many ethnicity options in maternity trak

Conclusions

• Ethnicity data is very completely & accurately recorded by maternity staff

• Differences in ‘meaning’ between terms ethnicity/nationality/CoB must be understood & interpreted in light of known national migration patterns

• Ethnicity & CoB data are important in examining access and equity of service provision – which is best to use depends on the subject and may require additional data such as preferred language.

Next stepsDisseminate findings and link with the Edinburgh Health and Ethnicity research group

Consider a simplified menu of ethnicity choices on maternity Trak

Undertake further work to address concerns that needs for interpretation/translation are not being adequately met

Maternity trak ethnicity is being used to:•Interpreter provision in maternity care•Ensure equity of provision of an intervention to improve access to postnatal contraceptive services•Audit of FGM care

Acknowledgements

• Niall Blackie for supplying the 2012 maternity TRAK data

• NRS for supplying the 2012 birth registrations• Dr Vittal Katikireddi• Ms Echo Lian for linking the two datasets• Additional Needs and Diversity Information

Task Force (ANDI TF) Chair Prof Bhopal – has led improvements in Lothian’s ethnicity recording

Births by ethnic group over time