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Greater Philly health system coalition removes race from clinical algorithm tools


Greater Philly health system coalition removes race from clinical algorithm tools

The regional coalition of health systems is reevaluating the role of race in tools used to assess kidney and lung function and other health conditions.

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Thirteen health systems in Greater Philadelphia are working as a coalition to reevaluate what role race has played in tools and guidelines that doctors and nurses use to diagnose and treat patients.

Some tools involve clinical algorithms or calculators designed to help guide providers as they decide who should get certain treatments, medications or procedures, and when.

And for many decades, these algorithms factored in race, because previous research and data that has since been disproven had indicated that different races of people had biological differences that were important to treatment decisions.

For example, a tool called the eGFR score is used to determine a person's kidney functioning, which is important in treating early kidney disease. It estimates the kidney filtration rate based on creatinine levels in the blood. The tool had used different numbers for Black patients since earlier research had found that they had higher creatinine levels in their blood. But experts now say that this meant that the tool often suggested that Black patients' kidneys were functioning better than they really were.

"They look up and they see a face that they think is Black and they say, 'Well, no, maybe it isn't as bad anymore,'" said Dr. Abiona Berkeley, an anesthesiologist at Temple University Health System. "So, you're late to diagnosis and you're late to treatment."

Spirometry is a lung function test that can help diagnose and monitor asthma, cystic fibrosis and other lung disorders. But calculations assumed that Black and Asian patients inherently have a smaller lung capacity compared to their white counterparts, so the test has failed to detect lung disease in many of these patients.

Providers now hope that by removing race as a factor, people will be more accurately evaluated for health conditions and get earlier access to care.

"At the end of the day, race is a social construct, it's not a scientific one," said Berkeley, who is also the interim senior associate dean of Diversity, Equity and Inclusion at Temple's Lewis Katz School of Medicine. "It's great to be in the space where we can start to deconstruct that. And that's what we're doing right now. We're really sitting down and dismantling it."

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