The Regional Coalition to Eliminate Race-Based Medicine (Regional Coalition) has announced that all its member health systems have transitioned away from race adjustments in clinical decision support tools that help guide lung, kidney, and OB-GYN care.
“Outdated beliefs about biological differences between races have for many years been embedded in decision support tools used in the practice of medicine. The Regional Coalition is working aggressively to change these tools to make them race neutral. We are extremely appreciative of the health systems that have committed to eliminating these inappropriate race-based adjustments," said Dr. Seun Ross, executive director of Health Equity at Independence Blue Cross (IBX) and coordinator of the Regional Coalition. IBX convened the Regional Coalition in 2023. "The work that each health system has done is already leading to improved outcomes in our region and over time will save and extend lives.”
For example, the hospitals and health systems in the region adopted a change in the estimated Glomerular Filtration Rate or eGFR (the kidney function test) calculation that has helped over 721 patients move onto and up on the kidney transplant list. As a result, 63 of those patients received a kidney transplant during 2023.
The group has also advocated to remove race from the Kidney Donor Risk Index, a formula used by the Organ Procurement and Transplantation Network to assess donor kidney quality. These are the first milestones for the Regional Coalition, and it helps ensure that residents in the Philadelphia area are being assessed with the most appropriate and evidence-based clinical decision tools.
In addition to the kidney function test, the tools the Regional Coalition addressed and are now race-neutral, include spirometry (a lung function test), the vaginal birth after cesarean (VBAC) calculator, and race-based gestational anemia guidelines. Removing the race adjustments in these tools will have profound impacts on patients in the Philadelphia region, including:
- Black and Asian patients with lung disease will be diagnosed earlier and receive the right treatments sooner.
- Black patients with chronic kidney disease will be identified sooner and more often, so they can get the treatment they need, including kidney transplants.
- More kidneys will be available for transplantation due to the removal of race from the Kidney Donor Risk Index, which plays a key role in determining which kidneys can be used for transplants.
- Black and Hispanic pregnant people will have the same opportunity to have a vaginal birth after a previous C-section as others who are pregnant.
- Pregnant Black people will be more likely to be accurately diagnosed with anemia and get the treatment they need. This will mean they have a lower risk of complications in childbirth or the postpartum period.
- Multi-racial people and people who identify outside of a race category that was previously included in one of these tools will no longer be excluded or receive unclear guidance.
“Temple Health is committed to the pursuit of equitable healthcare for all patients,” said Abiona Berkeley, MD, JD, FASA, Professor of Clinical Anesthesiology and Interim Senior Associate Dean of Diversity, Equity and Inclusion at the Lewis Katz School of Medicine at Temple University. “We are excited to partner with Independence Blue Cross and the other regional health systems in this groundbreaking initiative to ensure all of our patients are afforded maximal access to treatment.”
The Regional Coalition is focused on challenging race adjustments in 15 clinical decision support tools that may adversely impact patients’ outcomes. In addition to the tools that are now race-neutral, the Regional Coalition is working to address the use of race in the following:
- Arteriosclerosis and Cardiovascular Disease (ASCVD) Risk Estimator
- Breast Cancer Surveillance Consortium Risk Calculator
- Fracture Risk Assessment Tool (FRAX)
- Heart Failure Risk Score
- NCI Breast Cancer Risk Assessment Tool
- Osteoporosis Risk SCORE (Simple Calculated Osteoporosis Risk Estimation)
- Pediatric UTI Risk Calculator
- Rectal Cancer Survival Calculator
- Society of Thoracic Surgeons Short Term Risk Calculator
- Ureteral STONE Risk Score
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. It extends the work of Accelerate Health Equity, a collaborative to address and combat systemic racism in health care.