NYC Health + Hospitals ceases two race-based clinical assessments in new initiative

Photo: Marko Geber/Getty Images

NYC Health + Hospitals is putting a stop to a pair of diagnostic tests that use race-based calculations as part of a new "Medical Eracism" initiative, which seeks to eliminate biased, race-based assessments used for decades in hospitals and clinics across the country.

These assessments influence medical decisions that have been found to negatively impact the quality of care received by patients of color, the public healthcare system said.

The system announced it has already eliminated two common diagnostic tests – for kidney disease and vaginal birth after a cesarean delivery – that have embedded race-based calculations for severity of illness and risk, and can lead to implicit biases and errors in diagnosis and treatment.

The "Medical Eracism" project, led by the NYC Health + Hospitals Office of Quality and Safety and the Equity and Access Council, will identify additional areas of race-based assessments to recommend for elimination. 

WHAT'S THE IMPACT?

Through a partnership with NYC Health + Hospitals Nephrology Workgroup and Laboratory Council, the system will eliminate the use of race as a proxy to calculate kidney function. This proxy is known as glomerular filtration rate (eGFR). Historically, the eGFR is adjusted up for African-Americans, and categorizes all patients into "Black" and "non-Black." 

This practice, the system said, downplays the severity of illness in Black patients, and potentially reduces access to more aggressive treatment that can be life-saving. This includes delayed referrals for treatment, disqualification for transplants, and misguided treatment and counseling.

Instead, NYC Health + Hospitals will now use renal function eGFR calculations solely based on creatinine levels (a chemical waste product in the blood), age and sex for all patients. This is intended to improve care quality and prevent delays in care.

Through the Women's Health Council, the system is also eliminating the clinical risk calculation for Vaginal Birth After Cesarean-section. It is used to estimate the risk and likely success of labor for a vaginal delivery after an earlier C-section in a prior pregnancy. Formulated in 2007, the VBAC calculation includes risk factors, such as age, body mass index and clinical history of delivery, and whether the patient is of Black or Hispanic ethnicity.

Blacks and Hispanics are three times and at 1.5 times higher risk, respectively, of developing kidney failure than white Americans, the system said. Black women remain three-to-four-times more likely to die from pregnancy-related causes than white women in America.

THE LARGER TREND

The COVID-19 pandemic has highlighted racial disparities and inequities that exist in the healthcare system. Adding to mounting evidence of the disproportionate impact of the virus on some U.S. communities, an August 2020 analysis of hospitalization rates from the University of Minnesota showed Black, Hispanic, Native American and Alaskan Native populations in the U.S. are significantly more likely to be hospitalized due to COVID-19 than whites.

When compared to the populations of each state, people identified as being African American or Black were hospitalized at higher rates than those who were white in all 12 states reporting data, with Ohio (32% hospitalizations and 13% population), Minnesota (24.9% hospitalizations and 6.8% population), and Indiana (28.1% hospitalizations and 9.8% population) having the largest disparities.

Racial disparities even extend to the realm of telehealth, at least according to a December 2020 analysis published in JAMA Network Open. People who identified as Asian were 31% less likely to conduct a telehealth visit, and those who did not speak English were 16% less likely. Using Medicaid for insurance also made patients less likely to successfully conduct a virtual visit by 7%.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com