Meetings Examine Impact of Healthcare Algorithms on Racial and Ethnic Disparities in Health and Healthcare
In March 2023, the Agency for Healthcare Research and Quality (AHRQ), in partnership with the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health, held a 2-day meeting to explore the current use of computer algorithms in healthcare, their impact on racial/ethnic disparities in care, and approaches to identify and mitigate existing biases. The meeting was informed by an in-progress evidence report from the AHRQ Evidence-based Practice Center (EPC) Program examining the evidence on computer algorithms and racial and ethnic bias in healthcare, and approaches to mitigate such bias.
Key stakeholders presented additional perspectives on this topic, including initiatives to further explore and address identified challenges. The meeting was designed to inform the deliberations of a diverse panel of stakeholders who will offer guiding principles to address algorithmic bias at a followup public virtual meeting on May 15, 2023. Meeting materials are below:
- Meeting agenda from March meeting (PDF, 193 KB)
- Slides from March meeting:
- Research protocol for evidence report
Detailed Project Background
Healthcare algorithms are frequently used to guide clinical decision making both at the point of care and as part of resource allocation and healthcare management. The evidence report defines algorithms as mathematical formulas and models that combine different input variables or factors to inform a calculation or an estimate – frequently an estimate of risk. Algorithms are often incorporated into healthcare decision tools, such as clinical guidelines, pathways, clinical decision support programs in electronic health records, and operational systems used by health systems and payers.
Use of algorithms is expanding in many realms of healthcare, from diagnostics and treatments to payer systems and business processes. Every sector of the healthcare system is testing the technology to improve patient outcomes, accelerate research, and reduce costs. Although algorithms are widely used and can offer value in diagnostics and treatments, not all individuals benefit equally from such algorithms, creating inequities. This is primarily due to biases that result in undue harm to marginalized populations, such as racial and ethnic minorities, and perpetuate healthcare disparities. Recognition of such disparities has motivated a growing call for clinical algorithms to be both trained and validated on diverse patient data, with representation across spectrums of sex, age, race, ethnicity, and more. To rectify these issues, the field needs to understand when leveraging algorithms leads to unintended biases, how to identify biases before implementation, and what to do with biases discovered after implementation.
In fall 2020, AHRQ received a congressional request to commission an evidence review examining the use of race and ethnicity within healthcare algorithms, the extent of their use and impact on health disparities, and potential solutions for mitigating racial and ethnic biases to improve disparities and outcomes for racial and ethnic minorities. AHRQ subsequently issued a Request for Information to solicit public input, and commissioned an evidence review through its EPC Program to review the literature on the topic.
Supplementing the evidence review activities, AHRQ and NIMHD are sponsoring a panel of diverse experts representing varied stakeholder perspectives to contribute to development of guiding principles and actionable solutions for the use of race and ethnicity within healthcare algorithms. The evidence review and its follow-on expert panel activities will support the field in recognizing the potential for algorithms to mitigate or amplify racial/ethnic bias, understanding how to identify and/or prevent biases before implementation, and understanding how to mitigate biases discovered after implementation.
AHRQ and NIMHD are working collaboratively with other Federal agencies situated in the Department of Health and Human Services (HHS), including the Office of the National Coordinator for Health Information Technology, the HHS Office of Minority Health, the Centers for Medicare and Medicaid Services, the Office of the Assistant Secretary for Health, and others. Additionally, NORC at the University of Chicago is supporting AHRQ and NIMHD on this project and will serve as the main coordinator and facilitator of all the activities of the expert panel.
