Today, the Regional Coalition to Eliminate Race-Based Medicine (Regional Coalition) launches. The Regional Coalition members will work together to remove race “adjustments” from 15 commonly used clinical decision support tools that may adversely impact patients’ outcomes.
The Regional Coalition includes Children’s Hospital of Philadelphia, Doylestown Health, Grand View Health, Independence Blue Cross, Jefferson Health, Main Line Health, Nemours Children’s Health, Penn Medicine, Redeemer Health, St. Christopher’s Hospital for Children, Temple Health, Trinity Health Mid-Atlantic, and Virtua Health. This group, convened by Independence Blue Cross, has committed to focus on 15 clinical decision support tools that adjust results based on a person’s race, potentially causing delays and inequities in care. The group will work together to phase out the use of race as a variable in some of the tools. They will also collaborate on alternative best practices which do not reinforce a biological understanding of race.
“In many ways, race-based medicine has driven or contributed to the unacceptable health inequities that we see in the Philadelphia region and in other similarly situated communities across the country,” said Gregory E. Deavens, president and CEO at Independence Blue Cross. “Our region is known world-wide as a destination for health care excellence. That’s in large part due to the institutions represented in this Regional Coalition. This is another chance to show the spirit of innovation and exceptional leadership that are hallmarks of this great city and region by looking inward at how the medical establishment has unintentionally contributed to inequity over the years and resolving to change what has been ‘business as usual’.”
“Grand View Health supports the effort to identify tools that assume a biologic cause for illness or disease based on race. We will look to follow the guidance and best practices available, and we are proud to support the regional coalition to eliminate race-based medicine,” said Michael Prasto, MD, chief medical officer at Grand View Health.
Clinical guidelines and clinical decision tools help doctors determine the best way to care for their patients. Race is, in some cases, still used as one of the variables in those tools even though it is not an objective biological trait. Using race as a variable can adversely influence the care a patient receives. It can also impact their outcomes. An example is the spirometry test, widely used to assess a patient’s lung function. The equations used to interpret the test’s results often incorporate race and assume that Black and Asian patients have a smaller lung capacity compared to their white counterparts. As a result, the test has failed to detect lung disease in many Black and Asian patients.
“The health care system has a legacy of treating race as a biological fact, rather than a social construct,” said Dr. Seun Ross, executive director of Health Equity at Independence Blue Cross. “As a result, race has inappropriately become a component of many clinical decision tools in use today. We need to address it now so that all patients, no matter their background, have the best possible health outcomes.”
The Regional Coalition is focusing on 15 clinical decision tools to begin its work:
- Arteriosclerosis and Cardiovascular Disease (ASCVD) Risk Estimator
- Breast Cancer Surveillance Consortium Risk Calculator
- Estimated Glomerular Filtration Rate (eGFR)
- Fracture Risk Assessment Tool (FRAX)
- Heart Failure Risk Score
- Kidney Donor Risk Index (KDRI)
- NCI Breast Cancer Risk Assessment Tool
- Osteoporosis Risk SCORE
- Pulmonary-function tests/Spirometry
- Race-based Anemia Guidelines
- Rectal Cancer Survival Calculator
- Society of Thoracic Surgeons Short Term Risk Calculator
- Urology STONE Score
- UTI Calculation Guideline
- Vaginal Birth after Cesarean (VBAC) Calculator
The Regional Coalition extends the work of Accelerate Health Equity, which many of the participants, including Independence, are members. These organizations collaborate across the Philadelphia region to combat systemic racism and barriers in health care.