According to an Aug. 10 press release from Temple Health, the Regional Coalition to Eliminate Race-Based Medicine (Regional Coalition) launched. The Regional Coalition members will collaborate to remove race “adjustments” from 15 commonly used clinical decision support tools that may adversely impact patients’ outcomes.
The press release stated “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.”
Clinical guidelines and clinical decision tools exist to help physicians determine the best way to care for patients. Often, race is still used as one of these variables in those tools, although it is not an objective biological trait. Using race can impact outcomes, for example, in a spirometry test (the test is used to assess a patient’s lung function) the equations are used to interpret the test’s results sometimes include race and assume that Black and Asian patients have a smaller lung capacity compared to white patients. And as a result, the test has failed to detect lung disease in many Black and Asian patients.
The release added “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 work together across the Philadelphia region to combat systemic racism and barriers in healthcare.
Gregory E. Deavens, president and CEO at Independence Blue Cross was quoted in the release. He said, “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. 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’.”