Session: Racial Bias and Fairness in Healthcare Algorithms
De-Implementing Race-based Algorithms: Factors Influencing the Transition to Race-neutral Interpretations of Pulmonary Function
Saturday, September 21, 2024
8:45 AM – 9:45 AM CT
Location: Grand Ballroom C (First Floor)
Abstract: Previously, interpretation of pulmonary function tests (PFTs) relied on race-specific reference equations, which presumed that normal lung function is lower among Black than White individuals. This race-specific approach faced intense criticism within the past few years as it propagated a notion of biological essentialism to race, and it worsened health inequities among Black and Asian individuals by disadvantaging them in opportunities such as receiving disability benefits or obtaining a lung transplant. In 2023, the guidelines for PFT interpretation newly recommended use of a race-neutral approach, where lung function is interpreted the same way for all patients regardless of race. Despite the recommendation and its potential to promote distributive justice, the extent to which it has been implemented in practice remains unclear. Not all pulmonologists agree with a race-neutral approach, and some PFT labs currently use decades-old (and race-specific) interpretation standards, which together suggest significant challenges to de-implementing a race-specific approach to lung function interpretation. To better understand factors that influence PFT labs’ decision and ability to update to race-neutral reference equations, we are conducting semi-structured interviews with approximately 25 individuals—including medical directors, lab managers, and technicians—from PFT labs across the United States, who are recruited from a nationally available educational course on PFTs. Results from thematic analyses will be discussed. We will examine implications of our findings for ongoing efforts to combat racism in clinical algorithms, and we will discuss how they inform strategies to promote racial equity and distributive justice among patients with respiratory disease.
Learning Objectives:
After participating in this conference, attendees should be able to:
To understand how race-specific equations for the interpretation of lung function can promote racial inequity in distribution of medical resources.
To recognize factors that pose barriers or facilitate a transition to a race-neutral approach for interpreting lung function.
To explore potential strategies for promoting a transition away from a race-specific interpretation of lung function.
James Womer, MD – Division of Pulmonary and Critical Care Medicine – Johns Hopkins University; Diana Bouhassira, MD – Division of Pulmonary and Critical Care Medicine – Johns Hopkins Universtiy; Meredith McCormack, MD, MHS – Division of Pulmonary and Critical Care Medicine – Johns Hopkins University; Kadija Ferryman, PhD – Berman Institute of Bioethics – Johns Hopkins University; John H. Brems, MD,MBE,MHS – Post-doctoral Research Fellow, Berman Institue of Bioethics, Johns Hopkins University
