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’.”
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.
Quotes from Health Systems in the Regional Coalition
Children’s Hospital of Philadelphia
“For more than 170 years, Children’s Hospital of Philadelphia has been dedicated to helping children achieve their best health. We are delighted to join our colleagues to promote unbiased clinical care and implement best practices to create the healthiest environment for our children to live and to thrive,” said Tyra Bryant-Stephens, MD, medical director of the Community Asthma Prevention Program and chief health equity officer of the Center for Health Equity at Children’s Hospitals of Philadelphia.
“Every member of the health care team wants to do the right thing for our patients. In the past, race has come into a lot of decision-making calculators as a placeholder for socioeconomic status that is not appropriate. The use of race in many of these calculators is actually harmful, and, in many cases, it perpetuates biased health care inequities. It is important for all members of the health care team to objectively examine the way race is used in medicine, to help remove historical ingrained biases, so that all members of our community are provided with the best possible care and the best possible outcomes,” said Kieran Cody, MD, past president of the Doylestown Hospital medical staff and orthopedic sports medicine specialist.
Grand View Health
“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.
"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. The use of race to determine the course of treatment has gone unchallenged for far too long. We recognize the need to form strong partnerships to advocate for change across the health care 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," said Dwight W. McBee, executive vice president and chief experience officer at Jefferson Health.
Nemours Children’s Health
“As a leading multi-state children’s health system, Nemours Children’s Health is well-poised to act as a force-multiplier for health equity. This work is essential to eliminating healthcare disparities and supports Nemours Children’s vision for creating the healthiest generations of children,” said Rachel Thornton MD, PhD, FAAP, vice president and chief health equity officer at Nemours Children’s Health.
Main Line Health
“With our continued focus on delivering safe, high-quality, and equitable care, Main Line Health is proud to join the Regional Coalition to Eliminate Race-Based Medicine. Examining how race impacts patient care, including its use of clinical decision technology, is critical to overcoming disparities of care. Through the collaboration of committed health care organizations, we can address racism as a public health crisis,” said Jack Lynch, FACHE, president and CEO at Main Line Health.
“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. For many years, health care 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,” said Jaya Aysola, MD, MPH, founder and executive director of the Penn Medicine Center for Health Equity Advancement and an associate professor of Medicine and Pediatrics. “
“Redeemer Health’s mission, “Care, Comfort and Heal”, has a commitment to health equity and addressing health care disparity for all the members of the communities we are privileged to serve as evidenced by our programs in Women Health, Care for Seniors, Cancer Care Access, and Population Health, to name a few. As such, we are proud to partner with Independence Blue Cross and other health care providers in the region to address and eliminate the use of racial adjustments in clinical protocols,” said Carl Rosenbaum, MD, senior vice president of Population Health and chief medical officer at Redeemer Health.
St. Christopher's Hospital for Children
“St. Christopher's Hospital for Children is nationally recognized for our patient advocacy and dedication to providing the highest quality of healthcare to all children. We know that race is a social construct, and the elimination of race-based medicine is long overdue and a welcome change to ensure that patients are cared for equitably. When we recognize that structural inequities, not race, affect the health of our patients and their families, we're able to shift our collective focus to sustainable positive changes in healthcare. We look forward to collaborating with our colleagues in this effort,” said Rita Guevara, MD, FAAP, director of Health Equity at St. Christopher’s Hospital for Children.
“The mission of Temple University Hospital has always been to provide patients with the highest quality of medical care. Located in the heart of Philadelphia, we serve one of the nation’s most diverse patient populations with minority groups representing more than three-quarters of our surrounding community. We strongly believe that neither race nor zip code should negatively influence health outcomes. We are excited to partner with IBC through the Regional Coalition to eliminate these factors from the practice of medicine,” said Abiona Berkeley, MD, JD, interim senior associate dean of Diversity, Equity, and Inclusion, and professor of Clinical Anesthesiology for Lewis Katz School of Medicine at Temple University.
Trinity Health Mid-Atlantic
“Trinity Health Mid-Atlantic is proud to join Independence Blue Cross and a select group of large health systems from the tri-state region to form a coalition whose aim is to provide equitable care to all – regardless of race or socioeconomic status. This coalition will address structural racism in health care delivery focused specifically on implementation of alternative processes that do not use race correction. Our Trinity Health hospitals have already begun our journey to eliminate racism and advance health equity and have targeted race-based clinical algorithms for elimination. 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," said Sharon Carney, MD, senior vice president and chief clinical officer at Trinity Health Mid-Atlantic.
“All people deserve equal access to high-quality, safe health care. The coalition brings together the region’s leading health care organizations to address longstanding racial inequities in how medical decisions are made. Together, we will transform these processes at our own institutions and also advocate for them across our industry. At Virtua Health, we are proud and honored to be part of this groundbreaking effort, which will improve health outcomes for so many,” said Dennis W. Pullin, FACHE, president and CEO at Virtua Health.