C102-18 Implementing Race-neutral Reference Equations: Barriers and Facilitators for the Uptake of Gli-global

Abstract Rationale Race-specific reference equations for spirometry interpretation may underestimate disease severity among Black patients and may contribute to delayed diagnosis and treatment of respiratory disease. While recently updated ATS/ERS guidelines now recommend the use of the race-neutral GLI-Global equation, it is unknown to what degree pulmonary function testing (PFT) labs have implemented these equations and what factors may influence their decision. Methods We conducted 20 semi-structured interviews among medical directors, lab managers, or lab technicians at PFT labs in the United States or Canada. Participants were recruited from attendees of a nationally available education course on PFTs. Individual interviews were conducted via Zoom between February and April 2024. Two reviewers independently coded all transcripts using an inductive approach and revised discrepancies via in-person consultation. Coded excerpts were thematically analyzed using a reflexive approach to capture patterns related to barriers or facilitators to implementation of race-neutral equations for spirometry interpretation. Results Among all 20 participants, 12 (60%) were PFT lab managers, 7 (35%) lab technicians, and 1 (5%) medical director. A total of 9 (45%) participants practiced at a community medical center, and 13 (65%) practiced in an urban setting. GLI-Global had been implemented at 8 (40%) participants’ labs, while 10 (50%) were using GLI race-specific equations and 2 (10%) were using NHANES race-specific equations. Barriers to the implementation included: a complex decision-making process with multiple stakeholders, uncertainty about the impact of new equations among a lab’s local population, and a need to update software and hardware. Several participants noted pulmonologists as a key-stakeholder in the process who may be resistant to change. Potential facilitators for implementing GLI-Global included: ATS recommendations, resources to understand and communicate the impact of the change to GLI-Global, and accreditation systems. While ATS guidelines were highly important to participants, some respondents noted a desire for a method to be notified when guidelines are updated. Although U.S. PFT labs are not accredited, Canadian respondents noted the importance of an accreditation system in guiding their use of reference equations. Conclusion Despite the recommendations to use GLI-Global for spirometry interpretation, many PFT labs continue to use a race-specific approach. The identified barriers and facilitators highlight a need for strategies to improve implementation and suggest an important role for professional societies in promoting uptake. This abstract is funded by: NHLBI