Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms

Vyas, Darshali A; Eisenstein, Leo; Jones, David S.

doi:10.1056/nejmms2004740

Cited by 1,221 publications

(988 citation statements)

References 31 publications

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“…The racial, ethnic, socioeconomic, and gender disparities of the findings raise questions about the treatment pathways when considering the entire cohort of SUD patients. That is, to what extent, if any, are these covariate associations with routine discharge related to any systemic biases, a lack of coverage, or clinician bias particularly with respect to SUD patients who did not receive a consultation [17,39,40]? Alternatively, mistrust in medicine, perceived discrimination, self-reliance for substance misuse healing and treatment or lack of treatment readiness may also inform these associations (e.g., for patients who may have denied outpatient treatment or patients who did not receive a consultation) [22,40,41].…”

Section: Plos Onementioning

confidence: 99%

Differences in length of stay and discharge destination among patients with substance use disorders: The effect of Substance Use Intervention Team (SUIT) consultation service

et al. 2020

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Background Addiction medicine consultation services (ACS) may improve outcomes of hospitalized patients with substance use disorders (SUD). Our aim was to examine the difference in length of stay and the hazard ratio for a routine hospital discharge between SUD patients receiving and not receiving ACS. Methods Structured EHR data from 2018 of 1,900 adult patients with a SUD-related diagnostic code at an urban academic health center were examined among 35,541 total encounters. Cox proportional hazards regression models were fit using a cause-specific approach to examine differences in hospital outcome (i.e., routine discharge, leaving against medical advice, in-hospital death, or transfer to another level of care). Models were adjusted for age, sex, race, ethnicity, insurance status, and comorbidities. Results Length of stay was shorter among encounters with a SUD that received a SUIT consultation versus those admissions that did not receive one (5.77 v. 6.54 days, p<0.01). In adjusted analyses, admissions that received a SUIT consultation had a higher hazard of a routine discharge [hazard ratio (95% confidence interval): 1.16 (1.03-1.30)] compared to those not receiving a SUIT consultation. Conclusions The SUIT consultation service was associated with a reduced length of stay and an increased hazard of a routine discharge. The SUIT model may serve as a benchmark

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Section: Plos Onementioning

confidence: 99%

Differences in length of stay and discharge destination among patients with substance use disorders: The effect of Substance Use Intervention Team (SUIT) consultation service

et al. 2020

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“…A recent article from the New England Journal of Medicine questioned the use of race or ethnicity in assessment algorithms [1]. In the case of osteoporosis, the authors noted that the US FRAX calculator returns a lower fracture risk for women who are Black (by a factor of 0.43), Asian (0.50) or Hispanic (0.53).…”

Section: Introductionmentioning

confidence: 99%

FRAX and ethnicity

et al. 2020

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“…A recent publication in a prestigious medical journal, released June 17, 2020, reviewed race-based adjustments in selected clinical algorithms and described their "potential dangers" [1]. The USA adaption of the fracture risk assessment tool, FRAX [2], was cited as an example of an algorithm with the potential "to perpetuate or even amplify race-based health inequities."…”

mentioning

confidence: 99%