ABSTRACT
The Veterans Health Administration uses equity- and evidence-based principles to examine, correct, and eliminate use of potentially biased clinical equations and predictive models. We discuss the processes, successes, challenges, and next steps in four examples. We detail elimination of the race modifier for estimated kidney function and discuss steps to achieve more equitable pulmonary function testing measurement. We detail the use of equity lenses in two predictive clinical modeling tools: Stratification Tool for Opioid Risk Mitigation (STORM) and Care Assessment Need (CAN) predictive models. We conclude with consideration of ways to advance racial health equity in clinical decision support algorithms.
ABSTRACT
The legal doctrine of informed consent looms large over the medical profession with many interest groups trying to expand and narrow the doctrine, including patient rights advocates, managed care organizations, government agencies, and accreditation organizations. The legal profession itself has taken no small part in defining the doctrine. No physician today is practicing without the daily influence of law on his or her practice of medicine. The doctrine of informed consent, with all of its ambiguities and difficulties, has established a medical duty on the physician to make a reasonable attempt to unite the goals of the patient and the physician. Ultimately, physicians gain from the knowledge that their wisdom and skill has fostered a decision that is amenable to the patient. The patient gains from a facilitated decision that truly reflects that individual's self-determined will. As a result, both parties enjoy a newly formed partnership and the return of something that has long been taken for granted--trust in the physician-patient relationship.
