A groundbreaking move was made by a coalition of 12 Philadelphia-area health systems, as they announced on Monday their decision to eliminate race adjustments from four commonly used clinical tools. This decision, aimed at improving treatment and reducing delays in diagnosis for Black, Hispanic, and Asian patients, marks a significant step forward in the effort to address health disparities.
The use of race in clinical algorithms has been a contentious issue in the medical field, with many pointing out that it relies on outdated and inaccurate notions of race as a biological factor. This move by the Philadelphia coalition is one of the largest and most comprehensive efforts to date to remove race from these tools, reflecting a growing recognition of the harm they can cause to marginalized patients.
The initiative was spearheaded by Seun Ross, a physician and executive director of health equity at Independence Blue Cross, who recognized the importance of removing race from clinical tools. She emphasized the collective effort of all coalition members in driving this change, highlighting the impact of collaboration in addressing systemic issues.
One of the significant outcomes of this decision is the adoption of a race-free equation for calculating kidney disease severity, leading to 721 patients moving onto or up the kidney transplant list, with 63 receiving new kidneys in 2023. Other race-based tools being eliminated include those for lung function tests, assessing high-risk pregnancies for vaginal birth after cesarean delivery, and gestational anemia guidelines.
By removing race adjustments from these tools, the coalition aims to ensure earlier detection and treatment of lung disease for Black and Asian patients, proactive treatment for anemia during pregnancy for Black and Hispanic patients, and inclusivity for multiracial patients. The group is also working on challenging the use of race in several other clinical algorithms, such as those for heart disease, breast cancer, and pediatric urinary tract infections.
While the process of changing these algorithms is ongoing and challenging due to the lack of consensus and data in some cases, coalition members remain committed to removing race from them. Leaders from participating health centers expressed their enthusiasm for being part of this initiative and emphasized the importance of combating health disparities and racial stereotypes in healthcare.
The Philadelphia coalition is not alone in this effort, as a similar coalition in New York called CERCA has also made progress in addressing the use of race in clinical algorithms. Led by Michelle Morse, who has been a vocal advocate for removing race from algorithms, the group has seen positive outcomes from their work.
The Philadelphia coalition includes major health systems in the region, and members are hopeful that their actions will inspire other health systems to follow suit. By eliminating race as a consideration in medical treatment decisions, the coalition aims to ensure that all patients receive the care they deserve, regardless of their race or ethnicity.
