The regional coalition, which convenes under Independence Blue Cross, has so far removed race from clinical algorithms used in kidney function assessment, lung function testing, a calculator that estimates likelihood of a successful vaginal birth after cesarean (VBAC), and race-based gestational anemia guidelines.
“Now we are more proactive about Black people’s kidney health, and hopefully we see less people who end up with chronic kidney disease or on dialysis or needing a kidney transplant,” said Sean Ross, a family nurse practitioner and executive director of health equity at Independence Blue Cross.
Pharmacist Christine Roussel, senior executive director of pharmacy, laboratory and medical research at Doylestown Health, said providers are already seeing patients, especially Black patients, move up on the kidney transplant waiting list by several years after their eGFR scores were adjusted, “which is profound.”
The coalition supported the removal of race from the Kidney Donor Risk Index, which national organ and transplant networks use to calculate organ function of deceased donations. Advocates say the change should make more kidneys available, particularly from Black donors.
Leaders also hope that more Black and Hispanic mothers will be better informed about their labor and delivery options and get earlier proactive treatment for anemia, and that Black and Asian patients get earlier diagnoses and treatment for lung disease, more on par with their white counterparts.
“The coalition really opened my eyes to how extensive the problem was,” Roussel said. “I was really grateful when I got involved to be like, ‘Oh my gosh, there’s so much more work that we need to do.’”
Moving forward, the coalition plans to reevaluate how race is used in other clinical tools and algorithms that calculate risks for arteriosclerosis and cardiovascular disease, fractures, osteoporosis, pediatric urinary tract infections, breast cancer, heart failure and more.
Their focus areas are based on findings outlined in an article titled “Hidden in Plain Sight,” published in the New England Journal of Medicine in 2020. Researchers analyzed the level of understanding of race and human genetics among physicians and health care providers, and identified gaps in guidelines on clinical decision making.
“Our knowledge evolves,” Roussel said. “Our ability to look at the same data and form different theories related to them and to test them continues to evolve, and we’re always trying to do the best we can for our patients. That’s the best part of medicine, it’s forever changing, forever evaluating.”