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A health care algorithm offered less care to black patients
Care for some of the sickest Americans is decided in part by algorithm. New research shows that software guiding care for tens of millions of people systematically privileges white patients over black patients. Analysis of records from a major US hospital revealed that the algorithm used effectively let whites cut in line for special programs for patients with complex, chronic conditions such as diabetes or kidney problems.
The hospital, which the researchers didn’t identify but described as a “large academic hospital,” was one of many US health providers that employ algorithms to identify primary care patients with the most complex health needs. Such software is often tapped to recommend people for programs that offer extra support—including dedicated appointments and nursing teams—to people with a tangle of chronic conditions.
Researchers who dug through nearly 50,000 records discovered that the algorithm effectively low-balled the health needs of the hospital’s black patients. Using its output to help select patients for extra care favored white patients over black patients with the same health burden.
When the researchers compared black patients and white patients to whom the algorithm assigned similar risk scores, they found the black patients were significantly sicker, for example with higher blood pressure and less well-controlled diabetes. This had the effect of excluding people from the extra care program on the basis of race. The hospital automatically enrolled patients above certain risk scores into the program or referred them for consideration by doctors.
The researchers calculated that the algorithm’s bias effectively reduced the proportion of black patients receiving extra help by more than half, from almost 50% to less than 20%. Those missing out on extra care potentially faced a greater chance of emergency room visits and hospital stays.
