Achieving equitable care: The shift to race-neutral equations

Equations are fundamental tools in medical practice that aid in the assessment of vital organ functions such as those of the kidneys and lungs. As medical research evolves, these equations are continuously refined, or new ones are developed to incorporate factors that impact organ function. Historically, some of these equations have included race as a factor, which often led to inaccuracies and perpetuated health disparities. For instance, incorporating race into pulmonary function tests (PFTs) and estimated glomerular filtration rate (eGFR) equations commonly resulted in skewed assessments for certain racial groups, primarily Black patients. Recognizing these issues, expert panels and professional societies have recommended the adoption of race-neutral equations.¹

The American Thoracic Society (ATS) and a joint task force from the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) have played crucial roles in advocating for the removal of race from these critical equations. For example, the ATS has recommended a race-neutral average reference equation for PFTs as “race and ethnicity in PFT interpretation contributes to a false view of fixed differences between races and may mask the effects of differential exposures.”² Similarly, the NKF and ASN joint task force recommends using the updated eGFR 2021 CKD EPI creatinine equation, which excludes race as a factor.³

As specialty societies and other experts continue to refine clinical equations, the pace of uptake across health care varies due to several factors, including education and training for how to implement the revised equations within clinical practice. However, timely implementation of these updated guidelines is crucial for promoting health equity, as delays in adoption can perpetuate existing disparities and hinder the delivery of appropriate, value-based care. The InterQual^® content development team recognized the significant impact that implementing race-neutral equations would have on how patients are evaluated. To prepare for this change, they added informational notes throughout the InterQual criteria to ensure clinicians were aware of the ongoing work of the task forces to update these societal guidelines.

InterQual criteria are intended to be screening guidelines to help assess the clinical appropriateness of a clinical service. If criteria are not met, a secondary review process should be initiated, often at a physician level. Therefore, if an individual’s test results are subthreshold to criteria, clinicians should explore other possible considerations such as whether the test results may not have been determined using the recommended race-neutral equations. This will help ensure access to appropriate care and services for all patients.

This narrative underscores the importance of staying informed of, and aligned with, the latest evidence and literature changes which can have notable implications for advancing equitable care within clinical practice. The InterQual team’s ability to remain agile and vigilant in our surveillance and monitoring of the literature is reflected in our longstanding position as a trusted leader in this space.