A search of the ECRI guidelines trust for evidence-based guidelines addressing racial and ethnic health equity

Abstract

Clinical practice guidelines (CPGs) may not consistently address racial and ethnic health equity (RHE). This article discusses an audit of CPGs in the ECRI Guidelines Trust (EGT) aiming to summarize the extent and context in which CPGs address RHE, determine use of race-based recommendations, and determine inclusion of patient or public perspectives representing a racially or ethnically diverse group. A working group searched the EGT from 1 January 2020 to 31 January 2025 using RHE-related terms. They included CPGs that were developed by a U.S. organization in an adult population and underpinned by a systematic review that used RHE-related terms. They reviewed included CPGs and their supporting materials, extracted key characteristics, and narratively summarized key findings. The working group identified 137 full-text CPGs. Of these, 105 explicitly addressed RHE terms, whereas the remainder discussed equity or disparities more broadly. When explicitly addressed, RHE was most commonly included as part of the implementation considerations or in the discussion (78.1%). When incorporated into the conduct or methods of developing a guideline recommendation (64.7%), RHE was addressed in the search (8.8%), methods (33.8%), results (41.1%), or EtD or recommendation (39.7%). Although none of the guidelines included a race-based recommendation, 22.8% identified RHE evidence gaps. In total, 84.7% described racial and/or ethnic disparities in the clinical condition and 20% explicitly stated that race is a social construct. Only 3.3% expressly incorporated a racially or ethnically diverse patient or public perspective. However, the search was limited to the EGT, and search terms may not represent the full scope of RHE. Among CPGs addressing health equity, explicit consideration of RHE is mostly addressed in implementation considerations, with less incorporation into the methods or guideline recommendation.