A coalition of prominent health systems in the Philadelphia area, including in Bucks County, are taking a step toward eliminating race as a factor in medical decisions.
The Regional Coalition to Eliminate Race-Based Medicine, formed under the leadership of Independence Blue Cross, recently formed to seek to remove race “adjustments” from 15 key clinical decision tools. The aim is to address potential inequities and adverse impacts on patients’ outcomes.
Member institutions of the coalition include Children’s Hospital of Philadelphia; Doylestown Health, which operates Doylestown Hospital; Grand View Health, which is located in Upper Bucks County; Jefferson Health, which operates Jefferson Bucks Hospital in Falls Township; Main Line Health; Nemours Children’s Health; Penn Medicine; Redeemer Health; St. Christopher’s Hospital for Children; Temple Health; Trinity Health Mid-Atlantic,which operates St. Mary Medical Center in Middletown Township; and Virtua 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 Regional Coalition to Eliminate Race-Based Medicine said in a statement.
“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,'” said Gregory E. Deavens, president and CEO at Independence Blue Cross
Dr. Seun Ross, executive director of health equity at Independence Blue Cross, emphasized that the medical community has long treated race as a biological reality, rather than a societal construct. She said the problem needs to be fixed so all patients get the proper care.
Dr. Sharon Carney, of Trinity Health Mid-Atlantic, emphasized their dedication to eradicating racism in healthcare, noting their ongoing efforts to remove race-based clinical algorithms.
“We believe that prioritizing this area will offer the greatest impact and allow us to provide the best-possible evidence-based medicine to all our patients,” she said.
Dr. Kieran Cody, MD, president of the Doylestown Hospital medical staff and orthopedic sports medicine specialist, mentioned that race, often used as a surrogate for socioeconomic status in decision-making tools, has sometimes caused more harm than good, perpetuating health care biases.
“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 health care industry,” Jefferson Health’s Dwight W. McBee, who serves as executive vice president and chief experience officer.
The 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 work by the regional coalition amplifies the efforts of Accelerate Health Equity, a group that many coalition members are part of. The group continuously works together across Philadelphia to confront systemic racism and obstacles in healthcare.