Coalition to End Racism in Clinical Algorithms (CERCA) - NYC Health

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Coalition to End Racism in Clinical Algorithms (CERCA)

Right to Vaginal Birth After Cesarean Campaign

For educational and advocacy information on vaginal birth after cesarean for women and birthing people, families, and health care providers, visit Vaginal Birth After Cesarean.

The NYC Coalition to End Racism in Clinical Algorithms (CERCA) was formed to end the inclusion of race adjustment in clinical algorithms. Clinicians use clinical algorithms to guide their decision-making in the medical care of patients. Clinical algorithms using race adjustment often negatively impact treatment and care for people of color.

CERCA is expanding our scope of work to include:

A new focus area, race-based prescription in hypertension

An emphasis on downstream consequences of ending race adjustment in clinical algorithms.

Increased patient engagement in CERCA subcommittees

Previous work has focused on eliminating the use of race in the algorithms for Estimated Glomerular Filtration Rate, Vaginal Birth After Cesarean and Pulmonary Function Tests.

Since CERCA’s inception, most health system members have described significant institutional and team support for the work. Seven out of nine health systems have de-implemented or addressed the use of a race-based adjustment in one of the three priority clinical algorithms.

CERCA members successfully advocated for updated recommendations by the American Thoracic Society around de-implemented race-based reference equations in spirometry.

Over $3 million was received to evaluate processes and provide robust support to safety-net hospitals in their CERCA activities. An evaluation of the first iteration of CERCA activities will be published in 2024.

For more on CERCA’s work so far, see:

Summary (PDF)

Publications

Inaugural NYC Anti-Racism in Medical Education Symposium Report (PDF, 2023)

Inaugural CERCA Report (PDF, 2022).

Meeting Materials

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Previous Meetings

CERCA Meeting 12 Presentation (PDF, October 2023)

CERCA Meeting 11 Presentation (PDF, August 2023)

CERCA Meeting 10 Presentation (PDF, June 2023)

CERCA Meeting 9 Presentation (PDF, March 2023)

CERCA Meeting 7 Presentation (PDF, November 2022)

CERCA Meeting 6 Presentation (PDF, September 2022)

CERCA Meeting 5 Presentation (PDF, July 2022)

CERCA Meeting 4 Presentation (PDF, May 2022)

CERCA Meeting 3 Presentation (PDF, March 2022)

CERCA Meeting 2 Presentation (PDF, January 2022)

CERCA Meeting 1 Presentation (PDF, November 2021)

CERCA Subcommittees

Race-Based Prescription of Anti-Hypertensive Medications

Differences in Hypertension Medication Prescribing for Black Americans and Their Association with Hypertension Outcomes

Race and Antihypertensive Drug Therapy: Edging Closer to a New Paradigm

Hypertension Control in the United States 2009-2018: Factors Underlying Control Rates during 2015-2018 Across Age-and-Race-Ethnicity Groups

Population Care Management and Team-Based Approach to Reduce Racial Disparities among African Americans/Blacks with Hypertension (PDF)

Estimated Glomerular Filtration Rate

Estimated Glomerular Filtration Rate (PDF)

Establish OPTN Requirements for Race-Neutral eGFR Calculations (PDF)

Race and eGFR: Literature Review Through March 2022 (PDF)

On the Road to Health Equity Eliminating Race-Based Medicine at NYC H+H (PDF)

Examining the Potential Impact of Race Multiplier Utilization in Estimated Glomerular Filtration Rate Calculation on African-American Care Outcomes

Association of the Estimated Glomerular Filtration Rate With vs Without a Coefficient for Race With Time to Eligibility for Kidney Transplant

A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease

New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race

Not by Muscle, Race or Ethnicity: Practical use of Cystatin C to estimate GFR

Vaginal Birth After Cesarean

Reports and Resources

Vaginal Birth After Cesarean (PDF)

Race/Ethnicity and VBAC Calculator (PDF)

Challenging the Use of Race in the Vaginal Birth after Cesarean Section Calculator

ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery

Prediction of vaginal birth after cesarean delivery in term gestations: a calculator without race and ethnicity

Racial/Ethnic Differences in Socioeconomic Status and Medical Correlates of Trial of Labor After Cesarean and Vaginal Birth After Cesarean

Videos

Akia's Story

Jennifer's Story

Makeda - A Doula's Perspective

Helena - A Midwife's Perspective

Race in Vaginal Birth After Cesarean

Posters

What Is a Vaginal Birth After Cesarean? (PDF)

Testimonial Poster (PDF)

Pulmonary Function Tests

Pulmonary Function Tests (PDF)

ATS Statement on the Use of Race and Ethnicity in Pulmonary Function Test Interpretation (PDF)

Race/Ethnicity and Spirometry Reference Equations: A Review of the Literature (PDF)

World Lung Day 2022: Open Letter to American Thoracic Society to End Race Adjustment in Spirometry Testing (PDF)

Race, ethnicity and lung function: A brief history

The Impact of Race Correction on the Interpretation of Pulmonary Function Testing Among Black Patients (PDF)

Addressing Race in Pulmonary Function Testing by Aligning Intent and Evidence With Practice and Perception

Removal of “Race Correction” in Pulmonary Function Tests Shows More Prevalent and Severe Lung Disease Among Black Patients

Additional Resources

NYC Anti-Racism in Medical Education Symposium (NYCAMES)

Inaugural New York City Allied Medical Educational Symposium 2023

Inaugural NYC Anti-Racism in Medical Education Symposium 2023 - Recap

Inaugural NYCAMES 2023 – Opening Remarks

Inaugural NYCAMES 2023 - Bronx Inequities Presentation

Inaugural NYCAMES 2023 - Keynote Presentation

Keynote Presentation Slides (PDF)

Inaugural NYCAMES 2023 - Faculty Panel

Inaugural NYCAMES 2023 - Student Panel

Inaugural NYCAMES 2023 – Closing Remarks

Other Additional Resources

A Third Way: Race-Conscious Approaches to Health Inequities (PDF)