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University Health continues to shift to racially conscious health care

University Health is rethinking how race fits into diagnostic equations.

The hospital formerly known as Truman Medical Center is targeting racism in health care by removing race from the equation used to help diagnose kidney failure.

Better diagnoses, better care

Currently, most hospitals use an equation called the estimated glomerular filtration rate to evaluate kidney function. The equation takes race into account and produces two results, one for Black patients and one for non-Black patients.

With that equation, early kidney failure was often being missed in Black patients, and then not noticed until after the problem had escalated, said Yolanda Thompson-Martin, nurse practitioner in the University Health Diabetes, Endocrinology & Nephrology Center.

In March, University Health switched to an equation called cystatin C that does not include race. It is part of the hospital’s broader move away from race-based medical practice and toward racially conscious health care. The result of the switch: earlier detection of kidney disease, Thompson-Martin said.

“What I am seeing and what I do know is that with the equation that we’re doing now, we are seeing higher numbers of patients with declining kidney functions,” Thompson-Martin said.

For context, more than 37 million people in the U.S. have kidney diseases, according to the National Kidney Foundation. About 90% of those people don’t know they have it, and a disproportionate number of those are people of color. There are five stages of kidney disease, and at stage five, a patient is either on dialysis or they’re preparing for kidney replacement therapy or conservative care.

The new equation the hospital is using is much more sensitive, Thompson-Martin said, and alerts providers to issues faster. That way, health care providers can ramp treatments up to delay the progression of kidney failure before it gets to stage five.

By removing race from the equation, the hospital is hoping to provide more equitable measurement of kidney disease, increased access to equitable treatment options and equitable referral for transplants for Black patients, Thompson-Martin said.

Simply inputting a person’s race into an equation ignores substantial diversity and other variables, she said.

Historically, health care providers thought Black patients had more muscle mass, so that’s why race was taken into account in the eGFR equation (the creatinine level, part of the eGFR equation, is based upon muscle mass), said Christine Corbett, a nurse practitioner in nephrology and palliative care, and the associate chief nursing officer for advanced practice at University Health.

“What we found is that we were doing our African American patients a disservice,” she said.

Because their numbers may have been based on the race-based GFR equation, the hospital was referring Black patients for treatments later than non-Black patients, which meant the disease had progressed to a higher stage by the time they started dialysis.

“They were missing out on timely medical care,” Thompson-Martin said.

Jake Pitts, an equity, diversity and inclusion officer for the hospital, said many people may not know most hospitals are still using the eGFR equation.

And they also don’t realize that number can affect the course of their lives, he said. “The reasons for this mattering to patients is huge.”

A broader anti-racism effort

Race-based medicine is informed by beliefs about race as a social construct, Pitts said, and operates from myths about race and how people from different racial communities function. He said race-based medicine usually involves things that are not proven by science but continue to be furthered by medical education.

In contrast, race conscious health care involves interventions, closing gaps, reducing myths, and bias and microaggression workshops for hospital staff. That’s where University Health is moving.

Russell Anderson, also an equity, diversity and inclusion officer for the hospital, said University Health wants the community to know it’s made this change to how it diagnoses kidney disease, and that it’s just one piece of the University Health’s overall anti-racism work.

Anderson said University Health got involved in the Kansas City Health Equity Learning and Action Network early on and is aligned with the network’s purpose to help address racism in health care.

The hospital is continually looking to identify instances where race has been unfairly applied and is working to make changes.

Pitts said University Health is doing the work that needs to be done in an urban and academic health system. Hospital leaders want to educate the staff, provide quality, unbiased care, and show Kansas City that University Health cares about them and wants to take care of them.

“How huge is it to show our community how much trust could be built back into health care? Winning people’s trust again … that’s a huge thing,” he said.

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University Health continues to shift to racially conscious health care

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University Health continues to shift to racially conscious health care

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