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A Search of the ECRI Guidelines Trust for Evidence-Based Guidelines Addressing Racial and Ethnic Health Equity
Kelley N Tipton1, Danielle Mirda2, Anne Wert1
1ECRI, Plymouth Meeting, Pennsylvania (K.N.T., A.W.).
Annals of Internal Medicine
|October 27, 2025
Summary
Clinical practice guidelines (CPGs) often fail to fully integrate racial and ethnic health equity (RHE). While many CPGs acknowledge RHE, they rarely incorporate it into recommendations or diverse patient perspectives.
Area of Science:
- Health Services Research
- Health Equity Studies
- Clinical Practice Guideline Development
Background:
- Clinical practice guidelines (CPGs) are crucial for evidence-based healthcare.
- Addressing racial and ethnic health equity (RHE) within CPGs is essential for reducing health disparities.
- The extent to which current CPGs incorporate RHE remains unclear.
Purpose of the Study:
- To audit CPGs in the ECRI Guidelines Trust (EGT) to assess the integration of RHE.
- To determine how RHE is addressed within CPGs, including race-based recommendations and diverse patient perspectives.
- To summarize the scope and context of RHE in CPG development.
Main Methods:
- A systematic search of the EGT from January 2020 to January 2025 was conducted using RHE-related terms.
- CPGs developed by U.S. organizations for adult populations, based on systematic reviews, were included.
- Included CPGs and supporting materials were reviewed to extract characteristics and summarize findings on RHE.
Main Results:
- Of 137 CPGs, 105 explicitly addressed RHE, primarily in implementation or discussion sections (78.1%).
- RHE was less incorporated into guideline methods (33.8%) or recommendations (39.7%), with few race-based recommendations (0%) but identified evidence gaps (22.8%).
- Most CPGs described disparities (84.7%), few defined race as a social construct (20%), and very few included diverse patient perspectives (3.3%).
Conclusions:
- Explicit consideration of RHE in CPGs is often limited to implementation rather than core methodology or recommendations.
- There is a significant gap in incorporating diverse patient and public perspectives into guideline development.
- Further efforts are needed to systematically integrate RHE throughout the CPG development process to promote health equity.
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