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“Medical Eracism” Initiative Aims to Abolish Race-Based Assessments Used for Medical Decisions
May 17, 2021
NYC Health + Hospitals today announced the launch of its “Medical Eracism” initiative to eliminate biased, race-based assessments used for decades in hospitals and clinics across the country to influence medical decisions that have been found to negatively impact the quality of care patients of color receive. The public health care system announced it has already eliminated two common diagnostic tests – for kidney disease and vaginal birth after a cesarean delivery (VBAC) – 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 & Safety and the Equity & Access Council, will identify additional areas of race-based assessments to recommend for elimination. This initiative builds on the health system’s commitment to eliminate implicit bias in health care and provide equitable, quality care to more than one million New Yorkers who choose NYC Health + Hospitals as their medical home.
“Race is not a biological determinant, but a social construct. These calculations were based on racialized assumptions about biology that date back to slavery and the belief that somehow the bodies of African descendants where different from others,” said NYC Health + Hospitals Chief Medical Officer Machelle Allen, MD. “We also acknowledge that race matters in people’s health and remain cognizant of the impact of racism and social inequities affecting the health of New Yorkers under our care.”
“We have a critical investment in the health of all of the communities and populations we serve,” said NYC Health + Hospitals Senior Vice President and Chief Quality Officer Dr. Eric Wei. “Calculating medical conditions can be a matter of life or death in most cases. By eliminating some simple biological tests, we are helping to eliminate an element of systemic racism in medicine and sending our communities a message of how seriously we take the health and wellbeing of all of our patients.”
Eliminating Race as Proxy for Kidney Function
Through a partnership with NYC Health + Hospitals Nephrology Workgroup and Laboratory Council, the public health 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 downplays the severity of illness in Black patients potentially reducing access to more aggressive treatment that can save their life, including as a result of 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. Elimination of this formula will improve the quality of care for patients with renal disease and prevent delays in care.
Eliminating Race to Calculate Risk for Safe Vaginal Delivery after C-Section
NYC Health + Hospitals, through the health system’s Women’s Health Council, is also eliminating the clinical risk calculation for Vaginal Birth After Cesarean-section (VBAC). 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 (BMI), and clinical history of delivery, along with whether the patient is of Black race or Hispanic ethnicity.
Blacks and Hispanics are three-times and 1.5-times higher risk, respectively, of developing kidney failure than white Americans. Black women remain three-to-four-times more likely to die from pregnancy-related causes than White women in America.
With the launch of the “Medical Eracism” initiative, NYC Health + Hospitals leads the way in hospitals and health systems in New York City and across the country that have already eliminated the race-based calculation to assess and measure kidney function in patients and VBAC.