Validation of the uChicago Health Inequity Classification System (CHI-CS): A multi-institution pilot study

Health inequities permeate the American health care system, disproportionately impacting marginalized patients. The uChicago Health Inequity Classification System was developed in 2021 to facilitate structured discussions on bias and access at surgical morbidity and mortality conferences. This study sought to understand uChicago Health Inequity Classification System's impact and validate findings from the single-institution pilot study.

Three geographically disparate institutions implemented uChicago Health Inequity Classification System for at least 6 months and aggregated deidentified morbidity and mortality data during this time. A preintervention survey gauged faculty and trainee understanding and comfort discussing bias and access's role in surgical complications. Six months later, a postintervention survey evaluated uChicago Health Inequity Classification System's impact on morbidity and mortality and clinical practice. Pre- and post-intervention responses were compared using Kruskal-Wallis tests (P ≤ .05).

The pre- and postintervention survey response rates were 25% (98 respondents) and 16% (64 respondents), respectively. Across sites, bias and/or access contributed to 27% (34/125) of morbidity and mortality complications. Post-implementation, participants were significantly more comfortable recognizing bias- (P < .001) and access-related (P = .05) complications and discussing bias (P < .001) and access (P = .02) as causes for complications when assessed using Likert scales. uChicago Health Inequity Classification System enhanced morbidity and mortality for 89% of respondents, increased discussions of bias and access's impact on surgical outcomes (70%), influenced clinical practice and decision-making (46%), and was associated with perceived improvement in patient outcomes (24%).

Findings of this study were consistent with the single-institution pilot, demonstrating uChicago Health Inequity Classification System's generalizability and potential as a useful tool for promoting health equity in surgery. Future studies should explore its use across diverse practice settings.