Philadelphia-area hospitals will no longer factor race into screening tools for kidney, lung, and obstetrics care
The coalition led by Independence Blue Cross includes Penn Medicine, Jefferson Health, Temple Health, Main Line Health, Virtua and others.
Philadelphia’s leading health systems will no longer consider race in four common screening tools for lung, kidney, and obstetrics care, in an effort to make treatment more equitable for all patients.
Race has long been included in the algorithms that doctors use to evaluate patients and determine the best care plan. But mounting research has found that race is often not relevant to patients’ health and including it in clinical algorithms can lead to missed diagnoses, poor care, and worse outcomes for patients who are Black, Hispanic, and Asian.
» READ MORE: A Penn study on racial bias in health care algorithms shows “race is a bad variable”
For instance, the algorithm used to rank patients for placement on a kidney donor wait list previously overestimated the kidney function of Black patients by up to 20%, putting them lower on the list and reducing their chances of getting a new kidney.
After Philadelphia-area health systems updated the kidney function test, more than 700 patients moved up the kidney transplant list, the coalition announced Monday. Sixty-three received a kidney transplant in 2023.
The coalition also reconfigured guidelines used to evaluate anemia, a blood disorder that can be caused by iron deficiency, during pregnancy to more accurately diagnose anemia among Black people, reducing the risk of complications during or after birth.
The group also eliminated race from a lung function test, which is expected to help doctors diagnose lung disease earlier among Black and Asian patients.
The coalition plans to continue its work until it has evaluated all 15 such algorithms identified in a landmark 2020 study published in the New England Journal of Medicine that found their use of race systematically discriminated against some patients and widened racial gaps in health care.
» READ MORE: Philly hospitals and key insurers plan novel effort with the city to improve health equity
“Outdated beliefs about biological differences between races have for many years been embedded in decision support tools used in the practice of medicine,” said Seun Ross, executive director of health equity at Independence Blue Cross and coordinator of the coalition. “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.”
The coalition includes: Children’s Hospital of Philadelphia, Doylestown Health, Grand View Health, 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.
Race-based clinical tools can widen health disparities
Algorithms used to evaluate patients’ health have long included race as a proxy for perceived genetic differences. Doctors rely on such screening tools to help make decisions about whether their heart can withstand certain surgeries, how badly they need an organ transplant, and whether it is safe to attempt a vaginal birth after previously delivering by cesarean section.
Penn researchers who evaluated five dozen such algorithms found that factoring in race can sometimes result in more equitable care, while other times it exacerbates race inequities. The Penn study was not part of the coalition’s work.
For instance, the scoring system commonly used to determine whether it is safe for a person to attempt a vaginal birth after having a cesarean section (VBAC) previously deducted points for people who were Black or Hispanic. Doctors may then have been less likely to recommend Black and Hispanic patients attempt vaginal birth, potentially setting them up for another cesarean section, with higher rates of infection and longer recovery times.
» READ MORE: Can texting new parents to report their blood pressure help address maternal mortality? Penn thinks so.
The VBAC calculator is among the algorithms the Philadelphia coalition says it has adjusted to be race-neutral. The change could help narrow the racial gap in maternal mortality, with Black women more than twice as likely to die during childbirth or in the following months than white women.
“Not many people truly understand what health equity means and what it takes to get there,” Ross said. “The only way you can do that in a system that wasn’t designed for health equity is to look at the barriers and begin to dismantle them.”
Philadelphia-area hospital executives praised the work as essential change needed to improve care for patients.
“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,” Keith Leaphart, enterprise executive vice president at Jefferson, said in a statement. (Leaphart serves on the board of the Lenfest Institute, which owns the Inquirer.)
» READ MORE: For years, Black people have waited longer for kidney transplants because of their race. A new rule aims to fix that.
Philadelphia coalition plots next steps
Up next for the coalition: evaluating endocrinology screening tools and an algorithm for pediatric urinary tract infections that underestimates the likelihood of Black children developing an infection.
The group also hopes to work more closely with the coalition’s cancer centers to explore how retooling algorithms could help improve cancer diagnosis, treatment, and survival rates among Black, Hispanic, and Asian patients.
The Philadelphia health institutions involved in the effort recognize there’s much more to do.
“With race correction removed from our clinical decision tools, we must now examine the downstream care impacts of our changes,” Jaya Aysola, executive director of the Penn Medicine Center for Health Equity Advancement, said in a statement. “And then focus on what tools remain in the system that are problematic.”