HOPE Guidance Manual v1.02, Item A1005

Timepoint(s) Item Completed

Admission (ADM)

Item-Specific Instructions

• Ask the patient to select the category or categories that most closely correspond to the patient’s ethnicity

from the list in A1005.

• Respondents should be offered the option of selecting one or more ethnic categories.

• Ethnic category definitions are provided only if requested in order to answer the item.

• If a patient is unable to respond, a response from a caregiver and/or responsible party may be used.

• Only use medical record documentation to code A1005, Ethnicity if the patient is unable to respond and

no caregiver and/or responsible party provides a response for this item.

• If a patient declines to respond, code Y, Patient declines to respond, and do not code based on other

resources (caregiver, responsible party, or medical record documentation).

• If the patient can provide a response:

o Check all that apply.

• Check the box(es) indicating the ethnic category or categories identified by the patient.

• Code X, Patient unable to respond, if the patient was unable to respond.

o If the response(s) is/are determined via caregiver and/or responsible party input, and/or medical

record documentation, check all boxes that apply, including Code “X, Patient unable to respond.”

o If the patient is unable to respond and no other resources (caregiver and/or responsible party or

medical record documentation) provided the necessary information, code “X, Patient unable to

respond,” only.

• Code Y, Patient declines to respond, only if the patient declines to respond.

o When the patient declines to respond, code only “Y, Patient declines to respond.”

o When the patient declines to respond do not code based on other resources (caregiver, responsible

party, nor medical records). Complete as close to the time of admission as possible.

Coding Tips

• Standardizing self-reported data collection for ethnicity allows for the comparison of data within and across

multiple healthcare settings and is an important step in improving quality of care and health outcomes.

• These categories are NOT used to determine eligibility for participation in any Federal program.

Examples

1. The patient had an acute cerebrovascular accident (CVA) with mental status changes. During the

admission assessment, the patient is unable to respond to questions regarding their ethnicity. The

patient’s spouse informs the nurse that the patient is Cuban.

Coding: A1005 would be coded as “D, Yes, Cuban,” and “X, Patient unable to respond.”

Rationale: If a patient is unable to respond but the caregiver and/or responsible party provides the

response, check all boxes that apply, including Code “X, Patient unable to respond.”

2. Upon admission, the patient is asked about their ethnicity, but says they prefer to not answer the

question.

Coding: A1005 would be coded as Y. Patient declines to respond.

Rationale: If a patient declines to respond to this item, code “Y, Patient declines to respond.” Do not

use other resources (caregiver and/or responsible party or medical record documentation) to complete

this item when the patient declines to respond.