The 11-hospital healthcare system in New York City said 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, which the public health system said 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, the health system said.
The public health system said it will eliminate the use of adjustments to the glomerular filtration rate (eGFR) based on race. Historically, the eGFR is adjusted up for African Americans and categorizes all patients into “Black” and “non-Black.” But the health system said this practice downplays the severity of illness in Black patients, potentially reducing access to more aggressive treatments.
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.
The health system also is 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.
