Philadelphia Coalition to Eliminate Race-Based Clinical Decision Support Adjustments

Aug. 10, 2023
Convened by Independence Blue Cross, the group 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

A coalition of Philadelphia-area healthcare organizations will work 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 insurance company Independence Blue Cross, has committed to focusing 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 that 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 Deavens, president and CEO at Independence Blue Cross, in a statement. “Our region is known worldwide as a destination for healthcare 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’.”

Race is, in some cases, still used as one of the variables in clinical decision support tools, even though it is not an objective biological trait, the Regional Coalition said. 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 Regional Coalition is focusing on these 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

Several health system executives offered statements explaining the importance of this effort.

"Jefferson Health is committed to advancing health equity and we must be willing to challenge the systemic norms that may perpetuate inequities in clinical outcomes,” said Dwight McBee, executive vice president and chief experience officer at Jefferson Health. “The use of race to determine the course of treatment has gone unchallenged for far too long. Jefferson has already undertaken several initiatives to address this issue, including transitioning to a race-neutral estimation of kidney function resulting in over 100 Black patients newly eligible for transplant. We recognize the need to form strong partnerships to advocate for change across the healthcare industry. Jefferson Health is proud to be a part of the Regional Coalition to Eliminate Race-Based Medicine in our effort to eliminate race as a factor in our clinical decision-making tools,”

“We know that structural racism drives many inequities we see in health care, and one of the ways through which we can dismantle this is by actively examining how assumptions about race play a role in clinical practice, said Jaya Aysola, M.D., M.P.H., founder and executive director of the Penn Medicine Center for Health Equity Advancement and an associate professor of Medicine and Pediatrics. “For many years, healthcare providers have been working from the imprecise and incorrect idea that race is a biological concept.  By analyzing and correcting how race is utilized in medicine and considering its effects, we can calibrate our clinical care to reflect our updated understanding of race, racism, and the realities of patients we serve.”

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.

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