Multidisciplinary team paves way for removal of race-based clinical measurement tools
About two years ago, Philip Zazove, M.D., became curious as to why several race-based clinical measurement tools seemed to base their rationale for use more on the opinion of authors than on any actual data.
Around that time, the New England Journal of Medicine published a list of 12 commonly used algorithms that included race, despite the fact there was no good data for the inclusion of race.
Zazove brought this list to the Clinical Practice Council (CPC) of the U-M Medical Group (UMMG). The CPC agreed that the organization should either document evidence for the inclusion of race in those algorithms or investigate using them without the inclusion of race.
The CPC is composed of faculty from multiple specialties across the institution who make decisions about Michigan Medicine’s clinical care. After unanimous agreement, Zazove began the process for the CPC to evaluate these race-based clinical measurement tools.
Zazove identified expert faculty from each clinical area that used these tools and had one or more of these persons present their recommendations at the CPC. Most of the time, the experts agreed that there was no utility in including race and agreed to work with the UMMG to consider eliminating the use of the race-based algorithms.
“I have been impressed with how people have embraced this,” said Zazove, “which is important because it is the right thing to do.”
Each of the recommendations made by the experts were unanimously approved by the CPC. At the present time, nine of the original 12 algorithms have been modified to eliminate race.
Michigan Medicine is waiting for the national societies to make recommendations for two of the remaining three race-based algorithms, while the third will continue to be used because there’s currently no alternative.
In some cases, national societies such as the American Thoracic Society or American Society of Nephrologists, were consulted due to the impact it could have on patients nationally – for example, changing a measurement at Michigan could impact a patient’s eligibility for an organ transplant nationally.
More recently, two groups at U-M have begun researching the impact of the removal of the race-based component or use of the race-based measurement tool. One of this is the VBAC (Vaginal Birth After Cesarian) and the other is the eGFR. Both groups are looking at patient outcomes before and after the change.
While most patients will not likely be aware of the changes that occurred with these measurement tools, there will be increased equity in care such as in who’s recommended to have a Cesarian section.
This work has also been supported by the Anti-Racism Oversight Committee (AROC) and aligns with the institutional BASE values. It ensures all patients have access to safe and equitable medical care without bias.
“I can’t emphasize enough our focus and priority to provide equitable care to all of our patient populations,” said David C. Miller, M.D., U-M Health President and co-chair of the Anti-Racism Oversight Committee (AROC). “The work to eliminate inappropriate race-based algorithms will only elevate and enhance our clinical practice and the quality of care that we provide to our patients.”
Though much work has been done, Zazove and others expect they will continue to find other race-based clinical measurement tools used in clinical practice. They will seek to remove them or have them modified as pertinent.
In the meantime, our providers, patients and their families can feel better knowing that Michigan Medicine is hard at work promote equity and inclusion in patient care.