Framework, successful in Boston, now applied in New York, Virginia

“We advocate an approach to address racism in health care by enlisting the community and health care institutions as equal partners, equally motivated to identify and address inequalities in health and health care with race-conscious strategies that are necessary for people dealing with the effects of structural racism that kills them, their family members and their friends,” said Dr. Camara Jones MD, MPH, Ph.D., member of the Healing ARC Campaign Advisory Board.

“Historical data shows better health outcomes for patients referred to cardiology specialists, including lower 30-day readmission rates and better follow-up rates compared to patients admitted to general medicine,” said Dr. Michelle E. Morse, assistant professor at Harvard. medical school and chief medical officer and deputy commissioner of the New York City Department of Health.

The Healing ARC framework incorporates the three steps necessary to eliminate racism – naming, documenting and collaborating to repair the harm. Brigham and Women’s Hospital (BWH) in Boston is using the Healing ARC framework to eliminate inequities in the delivery of patient care.
In 2015, a study by doctors at BWH found that over a 10-year period, fewer black and Hispanic patients diagnosed with heart failure in the emergency department were admitted to the specialty cardiology unit, which improves patient outcomes. In response, physicians have developed a race-conscious Healing ARC model of care to address racial inequities and build accountability.

Dr. Bram P. Wispelwey, Harvard Medical Instructor

As part of a pilot program at BWH, a new, more equitable process is in place when the emergency room treats a person of color with heart failure.
Suppose a physician chooses to admit the patient to the general internal medicine ward rather than the cardiology ward. In this case, the clinician receives a “best practice advice” from the electronic health record system. The message reads: “The patient belongs to a racial or ethnic group with historically inequitable access to the cardiology service; consider modifying admission to Cardiology unless there is an extreme census or compelling clinical reasons for the general practice department. » The doctor can either modify his decision and admit in cardiology, or cancel the opinion of good practices and continue the admission in general medicine.
Through the pilot, which began earlier this year, results show the digital tool is having an impact on admitting Blacks and Hispanics to cardiology.

Dr. Morse co-led the original study and developed The Healing ARC with Dr. Bram P. Wispelwey, Instructor in Medicine at BWH and Instructor in the Department of Global Health and Population at Harvard TH Chan School of Public Health. We believe the Healing ARC framework can make a transformational difference in patient care,” said Dr. Wispelwey. “The approach serves two anti-racist goals by providing training for clinicians in recognizing racial inequity and providing an avenue for redress for patients of color.”

Dr. Morse also applies the Healing ARC framework in New York through the Coalition to End Racism in Clinical Algorithms (CERCA), which seeks to end racial adjustment in clinical algorithms and accelerate connections. to care for patients of color whose care has been delayed by the racist practice. Recently, CERCA published an inaugural report, stating that “equations based on race were often built on now debunked theories of race as biology.” The Healing ARC framework is also applied at the University of Virginia Medical Center.

A major component of The Healing ARC framework is to develop innovative approaches to working with the community. “Wisdom Councils” are held in communities of color that have suffered health disparities, allowing community voices to shape implementation. The first stage of the framework requires providers and institutions to recognize that racism contributes to inequitable health outcomes. The second stage is designed to repair the harm by offering compensation to the injured population, in particular by opening access to services and care that have been historically denied. The third step is to facilitate closure through reconciliation and agreement that the harm has been repaired.

The campaign’s goal is to expand Healing ARC apps to more hospitals, healthcare facilities, and public health facilities, while explaining why BWH’s care delivery model is needed, what can achieve and why race-conscious interventions are needed to dismantle racism in health care.