A coalition of 12 Philadelphia-area health systems announced Monday that its members have abandoned the use of race adjustments in four clinical tools commonly used to guide care, a move that health leaders say will improve treatment and prevent delays in diagnosis for Black, Hispanic, and Asian patients.
The decision marks one of the largest and broadest efforts to date to remove race from widely used clinical algorithms. The inclusion of race in dozens of these tools has sparked vigorous debates and roiled medicine since 2020, when many physicians began pointing out that the tools rely on faulty science that depicts race as biological, and that they can harm some already marginalized patients by making it seem they are healthier than they really are.
The topic was the focus of a STAT investigation, Embedded Bias, published last month. Many health systems are grappling with the issue, with some experts saying the race-based algorithms must be removed as quickly as possible to reduce health disparities and others saying the issue needs further study so patients are not inadvertently harmed by changes that aren’t fully vetted.
The work in Philadelphia started in earnest in 2023 when Seun Ross, a family nurse practitioner and executive director of health equity at Independence Blue Cross, said she realized that outdated notions about race needed to be removed from clinical tools. She thought that it was important that change came not only from her organization, but from many.
“We started reaching out to all of our partners, and asked if they wanted to join us in this work because we felt that it would be really, really impactful if it’s not just Independence working on this, but if we got all of our partners … to join us,” she said in an interview with STAT earlier this year. “Everyone is at the table.”
The health systems involved include most of the region’s major health systems, and they are already seeing positive results from the changes, Ross said. For example, the coalition’s adoption of a race-free equation to calculate kidney disease severity has resulted in 721 patients moving either onto or up the kidney transplant list. In 2023, 63 of those patients received new kidneys.
Other formerly race-based tools being dropped include a lung function test, a calculator that assesses whether women are at high risk to give vaginal birth after a cesarean delivery, which had previously led many physicians to recommend C-sections for Black mothers, and race-based gestational anemia guidelines.
Removing the adjustments, the group said, will mean Black and Asian patients will be more likely to have lung disease detected and treated earlier, and that Black and Hispanic patients will be more likely to get proactive treatment for anemia during pregnancy. In addition, multiracial patients will no longer be excluded from these tools or receive unclear guidance, coalition leaders said.
Ross said the coalition is continuing its work on challenging the use of race in several other clinical algorithms, including those assessing risk for heart disease and heart failure, breast cancer, bone fracture, osteoporosis, and pediatric urinary tract infections, as well as tools that predict rectal cancer survival, short-term risk of thoracic surgery, and risk of kidney stones.
Work on changing these algorithms is taking more time because there is less data, and in some cases, less work or consensus on the issue from the medical societies involved in the algorithms, to make the changes safely and ensure patient health. But coalition members said they would continue to work to remove race from them.
“Those tools may lack consensus on how to implement processes in them that disentangle race and ethnicity,” Jaya Aysola, who serves as executive director of the Penn Medicine Center for Health Equity Advancement, said in a statement. “Undoing existing care guidelines is often harder than introducing new ones.”
Leaders from participating health centers said they were excited to be part of the coalition and hoped the changes would help combat longstanding health disparities and racial stereotypes. “It’s essential to abandon outdated practices that perpetuate racial disparities,” Rosangely Cruz-Rojas, vice president and chief diversity and equity officer for Main Line Health, said in a statement. “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.”
The Philadelphia coalition is the second to take such action. A coalition in New York called CERCA, or the Coalition to End Racism in Clinical Algorithms, has reported that seven of its nine members have deimplemented or addressed the use of race in at least one algorithm. That coalition is led by Michelle Morse, who is currently serving as New York City’s interim health commissioner and has long been a leader in the effort to remove race from algorithms.
Morse has worked on the issue from her leadership perch and also from the U.S. House of Representatives, where she served as a health policy fellow. She has long urged health systems to take leadership on the issue since, as she previously told STAT, “accountability is lacking.”
The Philadelphia-area group 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.
Members said they hoped to see other health systems follow in their footsteps. “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,” said Cheryl Jackson, medical director of primary care for coalition member Trinity Health Mid-Atlantic.