Examining the History,
Consequences, and
Effects of Race-Based
Clinical Algorithms on
Health Equity

_____

Joe Alper, Ronique Taffe, and
Rose Marie Martinez, Rapporteurs

Roundtable on the Promotion of
Health Equity

Board on Population Health and
Public Health Practice

Health and Medicine Division

Proceedings of a Workshop

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and Aetna/CVS, American Medical Association, Blue Shield of California Foundation, Department of Veterans Affairs, Kresge Foundation, Merck, Takeda, and The California Endowment. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-71179-1
International Standard Book Number-10: 0-309-71179-7
Digital Object Identifier: https://doi.org/10.17226/27301

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Examining the history, consequences, and effects of race-based clinical algorithms on health equity: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27301.

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PLANNING COMMITTEE ON EXAMINING THE HISTORY, CONSEQUENCES, AND EFFECTS OF RACE-BASED CLINICAL ALGORITHMS ON HEALTH EQUITY¹

WINSTON F. WONG (Chair), Scholar in Residence, Kaiser Permanente UCLA Center for Health Equity

ALICIA J. COHEN, Research Investigator, Center of Innovation in Long Term Services & Supports, VA Providence Healthcare System

JUSTIN LIST, Director of Health Care Outcomes, Office of Health Equity, U.S. Department of Veterans Affairs

K. ALETHA MAYBANK, Chief Health Equity Officer, Senior Vice President, American Medical Association

ERNEST MOY, Executive Director, Office of Health Equity, U.S. Department of Veterans Affairs

REGINALD D. TUCKER-SEELEY, Vice President, Health Equity, ZERO Prostate Cancer

Staff

RONIQUE TAFFE, Program Officer/Study Director

ROSE MARIE MARTINEZ, Senior Board Director

Y. CRYSTI PARK, Program Coordinator

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¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

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ROUNDTABLE ON THE PROMOTION OF HEALTH EQUITY MEMBERSHIP¹

WINSTON F. WONG (Chair), Scholar in Residence, Kaiser Permanente UCLA Center for Health Equity, Los Angeles, CA

YVETTE CALDERON, Professor of Emergency Medicine, Mount Sinai Beth Israel, New York, NY

BRUCE (NED) CALONGE, Associate Dean for Public Health Practice, Associate Professor of Epidemiology, Colorado School of Public Health, and Associate Professor of Family Medicine, University of Colorado

CARLA CARTWRIGHT, Senior Director, Global Digital and Regulatory Policy, Johnson & Johnson, Washington, DC

LUTHER T. CLARK, Deputy Chief Patient Officer, Global Director, Scientific, Medical and Patient Perspective, Office of the Chief Patient Officer, Merck & Co., Inc.

MARIO R. DE LA ROSA, Distinguished and Endowed Health Equity University Professor, Professor of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami

ANA JACKSON, Chief Evaluation and Data Strategy Director, Blue Shield of California Foundation, Oakland

SHREYA KANGOVI, Executive Director, Penn Center for Community Health Workers, University of Pennsylvania, Philadelphia

K. ALETHA MAYBANK, Chief Health Equity Officer and Senior Vice President, American Medical Association, Chicago, IL

ERNEST MOY, Executive Director, Office of Health Equity, U.S. Department of Veterans Affairs, Washington, DC

CHRIS REDDICK, Vice President, Head of U.S. Health Equity, U.S. Public Affairs, Takeda Pharmaceuticals Company Limited

MELISSA A. SIMON, Vice Chair of Clinical Research, Department of Obstetrics and Gynecology, George H. Gardner Professor of Clinical Gynecology, Professor of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, and Director, Chicago Cancer Health Equity Collaborative, Northwestern University, Feinberg School of Medicine, Chicago, IL

TESHIA G. ARAMBULA SOLOMON, Associate Professor/Distinguished Outreach Faculty, University of Arizona, Tucson

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¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

REGINALD D. TUCKER-SEELEY, Vice President, Health Equity, ZERO Prostate Cancer, Los Angeles, CA

Veterans Health Administration Health Equity Roundtable Fellows

ALICIA J. COHEN, Research Investigator, Center of Innovation in Long Term Services & Supports, VA Providence Healthcare System; Assistant Professor of Family Medicine (Research), Alpert Medical School of Brown University, Assistant Professor of Health Services, Policy and Practice (Research), Brown University School of Public Health; Adjunct Lecturer, Department of Family Medicine, University of Michigan Medical School; Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI

SARAH JAVIER, Core Investigator, Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System (152-MPD), Menlo Park, CA

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by LESLIE SIM, National Academies of Sciences, Engineering, and Medicine. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

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Contents

1 INTRODUCTION

2 HISTORY OF RACE-BASED CLINICAL ALGORITHMS AND THEIR IMPACT ON ACHIEVING HEALTH EQUITY

Race in Prediction Models: Reconsidering Race Correction in Clinical Algorithms

Conceptualizations of Race and Inequity in Medical Education, Research, and Practice

3 MOVING FROM RACE-BASED TO RACE-CONSCIOUS MEDICINE TO ADDRESS HEALTH INEQUITIES

Race and eGFR: Lessons Learned and Future Directions

Implementation of Race-Free Equations

Race in Pulmonary Function Test Interpretation: History, Clinical Implications, Challenges, and Alternatives

Race-Based or Race-Conscious: Exploring the Utility and Function of Screening for Body Mass Index in Asian American Communities

4 EFFORTS TO PROMOTE RACE-CONSCIOUS MEDICINE IN HEALTH ORGANIZATIONS AND SYSTEMS

REFERENCES

APPENDIXES

A STATEMENT OF TASK

B PUBLIC MEETING AGENDA

C SPEAKER BIOSKETCHES

D BIOSKETCHES OF MODERATORS AND PLANNING COMMITTEE MEMBERS

Acronyms and Abbreviations