Abstract

Contents

• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Executive Summary
  • Main Points
  • Background and Purpose
  • Methods
  • Results
  • Limitations
  • Implications and Conclusions
  • References
• 1. Introduction
  • 1.1. Background
  • 1.2. Purpose and Scope of the Review
  • 1.3. Key Questions
  • 1.4. Contextual Questions
  • 1.5. Organization of This Report
• 2. Methods
  • 2.1. Methods To Address Key Questions
  • 2.2. Methods for Contextual Questions
  • 2.3. Peer Review and Public Commentary
• 3. Results
  • 3.1. Overview
  • 3.2. Key Question 1. What is the effect of healthcare algorithms on racial and ethnic differences in access to care, quality of care, and health outcomes?
  • 3.3. Key Question 2. What is the effect of interventions, models of interventions, or other approaches to mitigate racial and ethnic bias in the development, validation, dissemination, and implementation of healthcare algorithms?
  • 3.4. Contextual Question 1. How widespread is the inclusion of input variables based on race and ethnicity in healthcare algorithms?
  • 3.5. Contextual Question 2. What are existing and emerging national or international standards or guidance for how algorithms should be developed, validated, implemented, and updated to avoid introducing bias that could lead to health and healthcare disparities?
  • 3.6. Contextual Question 3. To what extent are patients, providers (e.g., clinicians, hospitals, health systems), payers (e.g., insurers, employers), and policymakers (e.g., healthcare and insurance regulators, State Medicaid directors) aware of the inclusion of input variables based on race and ethnicity in healthcare algorithms?
  • 3.7. Contextual Question 4. Select a sample of approximately 5–10 healthcare algorithms that have the potential to impact racial and ethnic disparities in access to care, quality of care, or health outcomes and are not included in KQs 1 or 2. For each algorithm, describe the type of algorithm, its purpose (e.g., screening, risk prediction, diagnosis), its developer and intended end-users, affected patient population, clinical condition or process of care, healthcare setting, and information on outcomes, if available.
• 4. Discussion
  • 4.1. Summary of Findings
  • 4.2. Applicability
  • 4.3. Evidence Gaps
  • 4.4. Strengths and Limitations
  • 4.5. Future Directions
  • 4.6. Conclusions
• References
• Abbreviations and Acronyms
• Appendixes
  • Appendix A. Methods for Search Strategy
  • Appendix B. List of Excluded Studies
  • Appendix C. Characteristics of Key Question 1 and 2 Studies
  • Appendix D. Key Question 1 and 2 Evidence Tables
  • Appendix E. Contextual Question 4 Detailed Supplement
  • Appendix F. Appendix References

Kelley Tipton, M.P.H., and Brian F. Leas, M.S., M.A. (Co-Leads)

Suggested citation:

Tipton K, Leas BF, Flores E, Jepson C, Aysola J, Cohen J, Harhay M, Schmidt H, Weissman G, Treadwell J, Mull NK, Siddique SM. Impact of Healthcare Algorithms on Racial and Ethnic Disparities in Health and Healthcare. Comparative Effectiveness Review No. 268. (Prepared by the ECRI-Penn Medicine Evidence-based Practice Center under Contract No. 75Q80120D00002.) AHRQ Publication No. 24-EHC004. Rockville, MD: Agency for Healthcare Research and Quality; December 2023. DOI: https://doi.org/10.23970/AHRQEPCCER268. Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the ECRI-Penn Medicine Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00002). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. Most AHRQ documents are publicly available to use for noncommercial purposes (research, clinical or patient education, quality improvement projects) in the United States, and do not need specific permission to be reprinted and used unless they contain material that is copyrighted by others. Specific written permission is needed for commercial use (reprinting for sale, incorporation into software, incorporation into for-profit training courses) or for use outside of the U.S. If organizational policies require permission to adapt or use these materials, AHRQ will provide such permission in writing.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality-enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

A representative from AHRQ served as a Contracting Officer’s Representative and reviewed the contract deliverables for adherence to contract requirements and quality. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis, interpretation of data, or preparation or drafting of this report.

AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Impact of Healthcare Algorithms on Racial and Ethnic Disparities in Health and Healthcare, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).