Implementation Across Five NYC Health Systems
CERCA coordinated the implementation of race-neutral PFT across five health systems in New York City. Their approaches included advocacy, financial support to health systems, clinician and staff education, patient engagement, and evaluation of clinical outcomes. Implementation timelines ranged from 9-24 months across participating institutions, with some transitions still ongoing.
The Path to Change
Founded in Fall 2021, the path to change that CERCA pursued accelerated a year later when Dr. Michelle Morse (Chief Medical Officer) and Dr. Ashwin Vasan (Commissioner) of the NYC Department of Health and Mental Hygiene released an open letter to the American Thoracic Society (ATS) urging removal of race modifiers from PFT equations. In March 2023, the ATS and European Respiratory Society recommended transitioning to race-neutral reference equations. Bringing race-neutral PFTs to institutions required acknowledgment of both aspects.
Implementation Strategies encompassed four key areas.
- Identifying project leads and stakeholders, including respiratory therapists conducting daily testing, pulmonary medicine colleagues interpreting studies, institutional administration providing top-down support, and centers for equity of care.
- Software upgrades requiring inventory of all PFT sites, early engagement with IT teams, and vendor collaboration.
- Workflow upgrades addressing the need to retrain respiratory therapy staff, who continued to input or select race/ethnicity options during PFT testing procedures despite new software and hardware.
- Comprehensive education targeting administration, patients, faculty, staff, and trainees through grand rounds sessions, workshops, and town hall meetings.
Barriers and Delays emerged in several areas. Vendor and IT constraints included finding compatible systems and addressing the fact that some systems were incompatible with upgrades and required replacement. Switching to race-neutral equations required respiratory therapists to learn new standardized protocols for how to conduct PFT testing.
Some older PFT platforms were unable to accommodate software updates, necessitating complete machine replacement. A survey in Fall 2024 revealed three primary implementation gaps: patient engagement, clinician and staff education, and understanding the impact on clinical decision-making and patient outcomes.
Moving Forward
With implementation timelines spanning up to two years and requiring coordination across respiratory therapy, pulmonary medicine, IT, and administrative teams, the CERCA experience demonstrates that transitioning to race-neutral clinical practices requires coordinated effort across multiple organizational levels and stakeholder groups. Their systematic approach to documenting barriers, strategies, and outcomes provides a model for other institutions undertaking similar equity-focused clinical practice changes.
Call to Action for Specialty Societies
Medical societies engaged in the move to race-neutral algorithms should document the barriers they encounter on their journey and the strategies used to overcome them. Sharing this information with other medical societies can support moving toward truly equitable medical care for all.