OAFP Board to Address Resolution on Removing Race as a Factor in Clinical Decision Support Tools

The following resolution, submitted and reviewed by the Ohio Academy of Family Physicians (OAFP) Speaker and Vice Speaker, will be considered by the Board of Directors during its meeting on Sunday, April 23.

Per OAFP policy, the Academy is now seeking member feedback on the “resolved” portions of the resolution. Please submit your comments below by Thursday, March 2. Comments submitted will be considered by the board as part of the discussion.

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Resolution Title: Advocacy for Removing Race as a Factor in Clinical Decision Support Tools
Introduced by: Ryan Kauffman, MD, FAAFP

WHEREAS, the AAFP recognizes that race is a social construct with no underlying genetic or biological factors that unite people within the same racial category,

WHEREAS, using race as a biological marker for disease states or as a variable in medical diagnosis and treatment may not accurately assess the true health status of a patient, leading to racial health disparities,

WHEREAS, the AAFP opposes the use of race as a proxy for biology or genetics in clinical evaluation and management and in research,

WHEREAS, in spite of the strong statements made by the AAFP about using race in medical decision making, there are still many tools commonly used in clinical practice that include race,

WHEREAS, the National Cancer Institute Breast Cancer Risk Assessment Tool returns lower risk estimates for women who are labeled African American, Hispanic/Latina, or Asian American and may inappropriately discourage more aggressive screening in these groups,

WHEREAS, the Organ Procurement and Transplantation Network: Kidney Donor Risk Index predicts an significantly increased risk of graft failure for African American donors which may increase racial inequality in access to kidney transplantation,

WHEREAS, spirometers in the United States use correction factors for persons labeled as Black or Asian that may result in the misclassification of disease severity and impairment for racial/ethnic minorities,

WHEREAS, the FRAX Fracture Risk Assessment Tool for the United States uses race in ways that delay treatment for patients labeled as Black, Hispanic, and Asian and does not use race as part of the calculation for most other countries, now, therefore be it

RESOLVED, that the AAFP partner with other physician, patient, and governmental organizations, when possible, to advocate for removal of race as a factor in clinical decision support tools, and be it further

RESOLVED, that the AAFP advocate for the National Institutes of Health (NIH) and the National Cancer Institute (NCI) to revise or replace the Breast Cancer Risk Assessment Tool so that it does not use race as a part of its calculation, and be it further

RESOLVED, that the AAFP advocate for the Health Resources and Services Administration (HRSA) and the Organ Procurement & Transportation Network (OPTN) to revise or replace the Kidney Donor Risk Index (KDRI) so that it does not use race as a part of its calculation, and be it further

RESOLVED, that the AAFP advocate for the National Institutes of Health (NIH), U.S. National Heart, Lung, and Blood Institute (NHLBI), and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to give guidance that race should not be a consideration when interpreting spirometry results, and be it further

RESOLVED, that the AAFP advocate for the Centre for Metabolic Bone Diseases at the University of Sheffield, UK to revise the FRAX calculation for the United States so that it does not use race as a part of its calculation.

Problem Statement
What specific practice problem does this resolution seek to solve, or, if this resolution pertains to a proposed new OAFP policy or change of policy, what issue does it seek to address?

The purpose of the resolution is to work for action to remove race from the clinical decision support tools that we as family physicians use every day. While the AAFP has taken a strong stand that race should not be used for clinical decision making, there are still many tools that utilize race.  This resolution proposes direct advocacy from the AAFP to the organizations that are responsible for these guidelines as a way to bring about change and reduce health inequity.

Problem Universe
Approximately how many OAFP members or members’ patients are affected by this problem or proposed policy?

While all OAFP members and all Ohio patients are impacted by the use of race as a factor in clinical decisions, members of racial minority groups are at the highest risk of inequitable health outcomes as a result of the use of these tools.

Proposed Solution
What specific solution are you proposing to resolve the problem or policy (i.e., what action do you wish the OAFP to take)?

The OAFP can take a resolution to the AAFP Congress of Delegates asking the AAFP to take action to directly advocate for changes to commonly used clinical decision support tools that currently use race.

Existing Evidence
What evidence do you have that indicates that a problem exists; or that there is a need for a new or revised policy? Please provide citations to support the existence of the problem and your proposed solution.

AAFP Race Based Medicine Policy: https://www.aafp.org/about/policies/all/racebased-medicine.html

Vyas DA, Eisenstein LG, Jones DS. Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms. N Engl J Med. 2020;383(9):874-882.

Westby A, Okah E, Ricco J. Race-Based Treatment Decisions Perpetuate Structural Racism. Am Fam Physician. 2020;102(3):136-137.  https://www.aafp.org/pubs/afp/issues/2020/0801/p136.html