Healing ARC Framework Applied to NYC Analysis of Racism in Clinical Algorithms Impacting Patient Care and Treatment

Dr. Bram P. Wispelwey

Dr. Michael Wilson

The Healing ARC Framework guides institutional racial equity initiatives to ensure the damage caused by structural racism is repaired and patients receive equitable care

It is critical that entities, like CERCA, work to eliminate the embedded racism that fuels the discriminatory behaviors, protocols, and patterns that shape patient care.

— Dr. Bram Wispelwey

BOSTON, MASSACHUSETTS, USA, October 18, 2022 /EINPresswire.com/ — Coalition targets clinical algorithms based on debunked theories of race and ethnicity

The New York City Health Department is building in the healing ARC framework to help shape initiatives that confront explicit and implicit racism in medicine and improve equity in patient care. The Healing ARC (Acknowledgment, Redress, and Closure), which encourages race-informed interventions, was developed to eliminate an inequity in the delivery of care to patients with heart failure at Brigham and Women’s Hospital (BWH) in Boston.

With guidance from The Healing ARC and other restorative paradigms, the NYC Department of Health prioritizes health justice, including leading the Coalition to End Racism in Clinical Algorithms (CERCA). Specifically, this coalition of 11 healthcare providers is examining the use of race and ethnicity in clinical algorithms that can play a central role in patient care decisions. But the race modifiers in these algorithms are often based on debunked racist theories, leaving patients with delayed and compromised treatment.

“Racism exists in medical research and health care systems in the United States, diminishing health outcomes for people of color,” said Dr. Bram Wispelwey, medical instructor at BWH and instructor in the Department of Global Health. and population at the Harvard TH Chan School of Public Health. “It is critical that entities, like CERCA, work to eliminate the embedded racism that fuels the discriminatory behaviors, protocols and patterns that shape patient care.”

The CERCA report cited several examples of harmful racial equations:
– Until recent changes in national guidelines, equations for estimating kidney function assigned a healthier “adjusted” value to black patients, sometimes delaying needed care, such as kidney transplants.
– Race modifiers in pregnancy-related tools disparately increased the likelihood of undergoing a repeat C-section for black and Latino pregnant women, potentially exacerbating inequalities at birth.
– Race-specific reference equations are used to assess the lung capacity of Asian, Black, and “Caucasian/Other” individuals, implying the presence of intrinsic racial differences in lung biology where none exist.

“Research over decades has demonstrated that human genetic variation cannot be meaningfully classified into socially and historically derived racial categories, yet far too many diagnostic algorithms and practice guidelines continue to biologize race into modifying their outcomes based on race or ethnicity,” said Dr. Wispelwey, a leader of the Healing ARC campaign, which seeks to expand implementation of the Healing ARC framework and other gender-aware interventions. race in hospitals and healthcare systems to eliminate racism in patient care.

Dr. Wispelwey and Dr. Michelle E. Morse, Chief Medical Officer and Deputy Commissioner of the New York Department of Health and Assistant Professor at Harvard Medical School, and others developed the Healing ARC framework after their study at BWH in Boston has found a pattern of inequity in the treatment of heart patients.

Over a 10-year period, on average, fewer black and Hispanic patients diagnosed with heart failure in the BWH emergency department were admitted to the specialty cardiology unit which improves patient outcomes. As part of a pilot program at BWH, when the emergency room treats a person of color with heart failure, a new, more equitable process is in place. Today, when an emergency physician selects a Black or Hispanic cardiac patient for general practice admission, the clinician receives an alert via the electronic health record system reminding them of the possibility of admitting to cardiology.

Prominent healthcare professionals, community leaders and advocates for healthcare equity recently launched the Healing ARC campaign to educate hospital administrators, legislators, social justice advocates and communities on the value of race-sensitive interventions. The campaign urges hospital administrators, lawmakers, social justice advocates and communities to support interventions inspired by The Healing ARC, as NYC does.

The CERCA report states that the Healing ARC framework “can guide institutional racial equity initiatives to ensure that the damage resulting from structural racism is repaired and that patients experience equitable improvement in care and outcomes. The Department of Health will explore the use of Healing ARC with CERCA members and patient advocacy groups as part of ongoing work to end racism in clinical algorithms.

CERCA creates a model to hold the scientific community accountable for real research, not debunked racial theories. In doing so, CERCA questions the “norms” of clinical algorithms that make biological distinctions according to race when none exist. It is a public health problem that affects not just individual patients, but entire communities for generations.

Dr. Michael Wilson, associate physician in emergency medicine at BWH and instructor at Harvard Medical School, said health equity cannot be achieved without eliminating “racial essentialism,” a belief in differences innate biology between racial groups.

“For centuries, this bad ideology has shaped science and managed to persist in medical education and clinical practice,” Dr. Wilson said. “Chronic diseases, from diabetes to hypertension and lung disease, exhibit racial inequities in incidence and impact and clear environmental and structural etiologies. Yet their racialized outcomes have often been misattributed to a intrinsic genetic or biological susceptibility or to “bad choices”.

About the Healing ARC Campaign
Our campaign educates hospital and health system administrators, legislators, social justice advocates, civic and community leaders about the effectiveness of race-conscious interventions, such as those implemented through Healing BOW. By implementing apps as part of Healing ARC, America can prevent health care inequities and improve the quality of life for many families and individuals.

Follow the Healing ARC campaign on social media:

Campaign Fact Sheet: https://healingarccampaign.com/campaign-fact-sheet/
Healing ARC Quotes: https://healingarccampaign.com/healing-arc-quotes/
Healing ARC website: https://healingarccampaign.com/
To schedule media interviews with physicians connected to the campaign, contact:
Michael K. Frisby
[email protected]

For hospitals and care centers interested in information on implementing The Healing ARC, contact:
Jennifer Goldsmith
[email protected]

Michael K. Frisby
Frisby & Associates
+1 240-988-9791
[email protected]

Sharon D. Cole