Clinical algorithms, or "pathways," promote the delivery of medical care that is consistent and equitable. Race, ethnicity, and/or ancestry terms are sometimes included in these types of guidelines, but it is unclear if this is appropriate for clinical decision-making. At our institution, we developed and applied a structured framework to determine whether race, ethnicity, or ancestry terms identified in our clinical pathways library should be retained, modified, or removed. First, we reviewed all text and associated reference documents for 132 institutionally-developed clinical pathways and identified 8 pathways that included race, ethnicity, or ancestry terms. Five pathways had clear evidence or a change in institutional policy that supported removal of the term. Multispecialty teams conducted additional in-depth evaluation of the 3 remaining pathways (Acute Viral Illness, Hyperbilirubinemia, and Weight Management) by applying the framework. In total, based on these reviews, race, ethnicity, or ancestry terms were removed (n = 6) or modified (n = 2) in all 8 pathways. Application of the framework established several recommended practices, including: (1) define race, ethnicity, and ancestry rigorously; (2) assess the most likely mechanisms underlying epidemiologic associations; (3) consider whether inclusion of the term is likely to mitigate or exacerbate existing inequities; and (4) exercise caution when applying population-level data to individual patient encounters. This process and framework may be useful to other institutional programs and national organizations in evaluating the inclusion of race, ethnicity, and ancestry in clinical guidelines.

中文翻译：

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临床路径中的种族、民族和血统：评估框架。

临床算法或“路径”促进提供一致和公平的医疗服务。种族、族裔和/或血统术语有时包含在此类指南中，但尚不清楚这是否适合临床决策。在我们的机构，我们开发并应用了一个结构化框架来确定临床路径库中确定的种族、民族或血统术语是否应该保留、修改或删除。首先，我们审查了 132 条机构开发的临床路径的所有文本和相关参考文件，并确定了 8 条路径，其中包括种族、民族或血统术语。有五个途径有明确的证据或机构政策的变化支持删除该术语。多专业团队通过应用该框架对其余 3 种途径（急性病毒性疾病、高胆红素血症和体重管理）进行了额外的深入评估。总的来说，根据这些审查，种族、民族或血统术语在所有 8 个途径中被删除 (n = 6) 或修改 (n = 2)。该框架的应用建立了几项推荐做法，包括：（1）严格定义种族、族裔和血统；(2) 评估流行病学关联最可能的机制；(3) 考虑纳入该术语是否有可能减轻或加剧现有的不平等现象；(4) 在将人群水平数据应用于个体患者就诊时要谨慎。这个过程和框架可能对其他机构项目和国家组织在评估临床指南中纳入种族、族裔和血统方面有用。