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Removing harmful race-based clinical algorithms: A toolkit

Introduction

For decades, race-based clinical algorithms and guidelines have quietly shaped medical decisions—delaying care and reinforcing systemic racism in healthcare. Marginalized communities and older adults have been disproportionately impacted, facing delays in life-saving treatments and leading to inequitable care.

Beginning in 2021, the New York City Health Department Coalition to End Racism in Clinical Algorithms (CERCA) led nine major NYC hospitals in successfully removing harmful race-based clinical algorithms from their systems. Their work has set a new precedent for racial equity in healthcare.

Now, you can build on this proven model. Our practical, action-oriented toolkit equips you with the strategies, resources, and real-world examples needed to eliminate harmful race-based algorithms and guidelines in your clinical setting—helping you improve patient outcomes and deliver safer, more effective care.

How you should use this toolkit

Whether you’re just beginning the conversation or ready to take action, this toolkit provides you with the structure, strategies, and real-world examples to help you lead meaningful change in your healthcare system. The process may take a few months, but each step is designed to be manageable and impactful—allowing you to make steady progress toward equitable care.

Start here if you are looking for a high-level overview of the de-implementation process, or need help making the case to organizational leadership. This will take you 30 minutes or less.

Start here if you are ready to dive into the full de-implementation process. There’s a lot to explore—plan to spend a few hours reviewing the activities and resources. It may seem overwhelming at first, but this toolkit is built to guide you step-by-step, making the process manageable and effective.

The Toolkit

Step 1 – Preparation & team building

Lay the groundwork by building a knowledgeable, committed team to drive the de-implementation process forward.

Step 2 – Readiness & needs assessment

Assess your team’s readiness with a self-assessment and identify gaps to build a strong foundation for de-implementation.

Step 3 – Algorithm & workflow adjustment

Replace harmful algorithms with race-conscious alternatives and update workflows to support sustainable change.

Step 4 – Provider education & training

Equip providers with the knowledge and skills to implement equitable care, including a Provider FAQ for quick answers to burning questions.

Step 5 – Patient engagement & restorative justice

Engage patients directly to address past harms and build trust through restorative justice efforts.

Are you a patient interested in learning more about the use of race in healthcare decision-making?

Our partners

We are deeply grateful to be the trusted organization by New York City Health Department Coalition to End Racism in Clinical Algorithms (CERCA) to build this important toolkit.

Thank you to The SCAN Foundation for supporting this critical work to bring equitable care to historically marginalized communities and older adults.

Additional resources to support your
de-implementation process

NYC Health Department

Coalition to End Racism in Clinical Algorithms (CERCA)

NYC Health Department

New York City Coalition to End Racism in Clinical Algorithms (CERCA): Inaugural Report

NYC Health Department

Race to Justice Glossary

The New England Journal of Medicine

Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms

US House Ways & Means Committee

Fact vs. Fiction: Clinical Decision Support Tools and the (Mis)use of Race

Centers for Medicare & Medicaid Services (CMS)

Nondiscrimination in Health Programs and Activities

Agency for Healthcare Research and Quality (AHRQ)

Impact of Healthcare Algorithms on Racial and Ethnic Disparities in Health and Healthcare

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