Article type
Abstract
Background: Systematic reviews (SRs) and guidelines may not consistently address racial and ethnic health inequities. The Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program has interest in understanding how SRs can better address issues of racial and ethnic health equity (RHE).
Objective: To systematically audit if, when, and how RHE has been addressed and discussed in publicly-nominated EPC evidence review suggestions, EPC evidence reviews, and the ECRI Guidelines Trust (EGT) database, a publicly available repository. These efforts are informing an AHRQ, Cochrane, and Robert Wood Johnson Foundation-supported RHE Summit.
Methods: An AHRQ EPC methods workgroup reviewed and extracted data from EPC nominations, EPC reviews, and guidelines in the EGT over the past five years. Two individuals reviewed the evidence reviews and guidelines, and results were compared for consistency. Items identified included whether equity was the focus, whether an evidence review was developed addressing the nomination, whether equity was within scope, and how equity was incorporated into reviews and clinical recommendations.
Results: Of 202 nominations, 19 directly pertained to RHE. Four were selected for evidence review development. When RHE was included in the review scope, race was often included as a subgroup analysis for effectiveness questions, and SRs did not indicate whether it served as a proxy for other types of disadvantage. Less frequently, RHE was included as a contextual question or as a part of the discussion of evidence applicability and considerations for healthcare decision-making. A subset of SRs explicitly focused on RHE and described barriers, facilitators, and solutions for disadvantaged groups. In the EGT audit, explicit discussions of equity were rare, and when noted, primarily discussed with implementation considerations for guideline recommendations. There were examples reporting differences in disease prevalence by race and ethnicity without describing plausible mechanisms, potentially perpetuating the false notion that race is a biologic construct.
Conclusion: SRs and guidelines do not consistently and adequately address RHE, despite recognition of pervasive racial and ethnic health disparities across clinical conditions. This audit of three data sources identifies a range of approaches taken, and opportunities to expand discussions on equity in SRs and guidelines.
Objective: To systematically audit if, when, and how RHE has been addressed and discussed in publicly-nominated EPC evidence review suggestions, EPC evidence reviews, and the ECRI Guidelines Trust (EGT) database, a publicly available repository. These efforts are informing an AHRQ, Cochrane, and Robert Wood Johnson Foundation-supported RHE Summit.
Methods: An AHRQ EPC methods workgroup reviewed and extracted data from EPC nominations, EPC reviews, and guidelines in the EGT over the past five years. Two individuals reviewed the evidence reviews and guidelines, and results were compared for consistency. Items identified included whether equity was the focus, whether an evidence review was developed addressing the nomination, whether equity was within scope, and how equity was incorporated into reviews and clinical recommendations.
Results: Of 202 nominations, 19 directly pertained to RHE. Four were selected for evidence review development. When RHE was included in the review scope, race was often included as a subgroup analysis for effectiveness questions, and SRs did not indicate whether it served as a proxy for other types of disadvantage. Less frequently, RHE was included as a contextual question or as a part of the discussion of evidence applicability and considerations for healthcare decision-making. A subset of SRs explicitly focused on RHE and described barriers, facilitators, and solutions for disadvantaged groups. In the EGT audit, explicit discussions of equity were rare, and when noted, primarily discussed with implementation considerations for guideline recommendations. There were examples reporting differences in disease prevalence by race and ethnicity without describing plausible mechanisms, potentially perpetuating the false notion that race is a biologic construct.
Conclusion: SRs and guidelines do not consistently and adequately address RHE, despite recognition of pervasive racial and ethnic health disparities across clinical conditions. This audit of three data sources identifies a range of approaches taken, and opportunities to expand discussions on equity in SRs and guidelines.