Philadelphia-area coalition announces the end of race adjustments in four clinical decision support tools used in lung, kidney, and OB-GYN care

PHILADELPHIA, Oct. 21, 2024 /PRNewswire/ -- 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"Outdated beliefs about biological differences between races have for many years been embedded in decision support tools used in the practice of medicine.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.

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.

About Independence Blue Cross:
Independence Blue Cross is the leading health insurance organization in southeastern Pennsylvania. For more than 85 years, we have been enhancing the health and well-being of the people and communities we serve. We deliver innovative and competitively priced health care products and services; pioneer new ways to reward doctors, hospitals, and other health care professionals for coordinated, quality care; and support programs and events that promote wellness. To learn more, visit ibx.com. Connect with us on Facebook, X (formerly Twitter), LinkedIn, and Instagram. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

Quotes from Health Systems in the Regional Coalition

Children's Hospital of Philadelphia
"The Coalition has done the important work of tackling clinical pathways to remove race-based practices that promote health disparities," said Tyra Bryant-Stephens, Medical Director of the Community Asthma Prevention Program and Chief Health Equity Officer of the Center for Health Equity at Children's Hospital of Philadelphia. "We want Philadelphia to be the healthiest city in the nation, and working together is the best way to accomplish that goal." 

Doylestown Health
"The delay between new research and routine patient care is said to be approximately 17 years in medicine, and even greater for marginalized populations. For Doylestown Health, being part of the Regional Coalition to Eliminate Race-Based Medicine has reduced the research to practice gap by creating forums for local healthcare teams to evaluate evolving practice guidelines and provide peer support as well as accountability for the shared goal of removing race from clinical calculators. Inequity in healthcare is multi-factorial, and removing race from clinical calculators is just one of many steps needed to create global change," said Christine Roussel, PharmD, BCOP, BCSCP, Vice President, Clinical Support Services for Doylestown Health.

Grand View Health
"We are grateful for the leadership of Independence Blue Cross and value the partnership of our neighboring health systems in supporting the important work of the Regional Coalition to Eliminate Race-Based Medicine," said Grand View Health Chief Medical Officer Michael Prasto, MD. "Providing high-quality care that assures the best possible health outcomes to all patients is at the core of Grand View Health's mission and we are committed to de-implementing the use of race "adjustments" across the entire continuum of care."

Jefferson Health
"Jefferson Health remains steadfast in our commitment to advancing health equity by challenging outdated practices that contribute to disparities in care. The recent elimination of race adjustments in clinical decision support tools is a significant milestone in our efforts to ensure that all patients receive the most effective treatment. Our partnership with the Regional Coalition to Eliminate Race-Based Medicine reflects our dedication to transforming healthcare for the better. Together, we are working to create a system where decisions are based solely on individual health needs, not race, ultimately leading to improved outcomes for all patients," said Keith Leaphart, DO, MBA, Enterprise Executive Vice President and Humana Chief Health Equity and Community Impact Officer at Jefferson. 

Main Line Health
"As a health system committed to delivering safe, high-quality, equitable and affordable care to our patients and the communities we serve, it's essential to abandon outdated practices that perpetuate racial disparities. By eliminating race adjustments in clinical decision support tools, we can help to dismantle harmful stereotypes and ensure that everyone receives the care they deserve, regardless of their race or ethnicity," said Rosangely Cruz-Rojas, DrPH, Vice President and Chief Diversity & Equity Officer for Main Line Health.

Nemours Children's Health
"Nemours Children's Health is proud to be a part of this Regional Coalition, having embraced the work of eliminating the use of certain race-based algorithms across our entire multi-state pediatric health system," said Dr. Rachel Thornton, Vice President, Chief Health Equity Officer of Nemours Children's Health. "We have received tremendous support for the continued focus on pediatric clinical decision-making tools and outcomes, which will lead us to continue creating the healthiest generations of children no matter their race."

Penn Medicine
"With race correction removed from our clinical decision tools, we must now examine the downstream care impacts of our changes, and then focus on what tools remain in the system that are problematic. Those tools may lack consensus on how to implement processes in them that disentangle race and ethnicity," said Jaya Aysola, MD, DTMH, MPH, Executive Director of the Penn Medicine Center for Health Equity Advancement. "Undoing existing care guidelines is often harder than introducing new ones and requires a different set of de-implementation strategies. It's also important that we be vigilant of forthcoming research and guidelines that could reintroduce race correction in new ways, since it is critical to build upon the real progress that we have made already."

Redeemer Health
"Reducing disparity and inequity in health care is key to helping humans flourish as a people, which is the heart of our mission to care, comfort and heal," said Joshua M. Jenkins, Redeemer Health's Vice President of Mission Integration and Pastoral Care. "We are proud that our health care ministry contributes to this important work."

St. Christopher's Hospital for Children
"At St. Christopher's Hospital for Children, we are proud to partner with Independence Blue Cross as part of the Regional Coalition to Eliminate Race-Based Medicine," said Rita Guevara, MD, FAAP, Director of Health Equity at St. Christopher's. "We follow the latest evidence-based practice guidelines for our patients, and the work that the Regional Coalition is doing to create uniformity in patient care further augments our collective goal of health equity. We look forward to continuing to collaborate with IBX and other health organizations in the Philadelphia area on this important work."

Temple Health
"Temple Health is committed to the pursuit of equitable healthcare for all patients. 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," said Abiona Berkeley, MD, JD, FASA, Professor of Clinical Anesthesiology, Interim Senior Associate Dean of Diversity, Equity and Inclusion, and Lewis Katz School of Medicine at Temple University.

Trinity Health Mid-Atlantic
"It's uplifting to see all the work being done in our region, and across the nation, to remove race as a consideration to inform medical treatment. Trinity Health Mid-Atlantic was an early adopter of this initiative to improve patient outcomes among non-white individuals through removal of race-based algorithms in clinical practice and treatment protocols, and to that end, we're just as committed to its advancement and expansion. As we continue the Regional Coalition's work, we have engaged a core group of Trinity Health Mid-Atlantic physicians to uncover any remaining clinical protocols in need of amendment or outright elimination," said Cheryl Jackson, MD, Medical Director of Primary Care for Trinity Health Mid-Atlantic.

Virtua Health
"As a founding member of the Regional Coalition, Virtua Health is extremely proud of the work this group has done to improve health equity in our region and beyond. We firmly believe that every person should have a fair opportunity to achieve their best possible health. Sadly, that has not been the case for many of us, for far too long. Independence Blue Cross and the Regional Coalition are doing vital work to enable all members of our communities—regardless of their race—to live healthier, longer lives," said Lisa Ferraro, President of Virtua Our Lady of Lourdes Hospital and Senior Vice President for Virtua Health.

SOURCE Independence Blue Cross