Removal of race-based clinical measurement tools

This article was additionally edited by Brittanii Lyons.

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 use of race. Zazove brought this list to the Clinical Practice Council of the University of Michigan Medical Group (UMMG).

This council is composed of doctors from multiple specialties across the institution who make decisions about Michigan Medicine's clinical care. The practice council agreed that you should either show evidence for the use of race in those tools or consider using them without race. After unanimous agreement, Zazove began the process for the clinical practice council to evaluate these race-based clinical measurement tools.

Zazove identified experts from each clinical area that used these tools and had them present their recommendations at the council. Most of the time, the experts agreed that there was no reason for including race and agreed to work with the medical group to consider eliminating the use of the race-based tools.

"I have been impressed with how people have embraced this," said Zazove, "which is important because it is the right thing to do."

In some cases, national societies such as the American Thoracic Society or American Society of Nephrology, 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. Each of the recommendations made by the experts were unanimously approved by the council.  At the present time, nine of the original 12 measurement tools have been modified to eliminate race. Currently, U-M is waiting for the national societies to make recommendations for two of the three remaining three race-based algorithms, while the third will continue to be used because there's currently no alternative.

More than likely, patients will not be aware of the changes that occurred with these measurement tools - but it is anticipated that patients will see increased equity in care, such as in who's recommended to have a caesarean section. Two groups at Michigan have also begun researching the impact of the changes from the clinical measurement tools to patients and clinicians. One group is studying the VBAC, short for vaginal birth after C-section, and the other is focused on kidney function. This work 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-Racist Oversight Committee.  "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 patient care. They will seek to remove them or have them modified. And in the meantime, our care givers, patients, and their families can feel better knowing that Michigan Medicine is hard at work promote equity and inclusion in patient care.