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Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis
The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationali...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American College of Chest Physicians. Published by Elsevier Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521357/ https://www.ncbi.nlm.nih.gov/pubmed/32991873 http://dx.doi.org/10.1016/j.chest.2020.09.246 |
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author | Ehmann, Michael R. Zink, Elizabeth K. Levin, Amanda B. Suarez, Jose I. Belcher, Harolyn M.E. Daugherty Biddison, Elizabeth L. Doberman, Danielle J. D’Souza, Karen Fine, Derek M. Garibaldi, Brian T. Gehrie, Eric A. Golden, Sherita H. Gurses, Ayse P. Hill, Peter M. Hughes, Mark T. Kahn, Jeffrey P. Koch, Colleen G. Marx, Jason J. Meisenberg, Barry R. Natterman, Jeffrey Rushton, Cynda H. Sapirstein, Adam Selinger, Stephen R. Stephens, R. Scott Toner, Eric S. Unguru, Yoram van Stone, Maureen Kachalia, Allen |
author_facet | Ehmann, Michael R. Zink, Elizabeth K. Levin, Amanda B. Suarez, Jose I. Belcher, Harolyn M.E. Daugherty Biddison, Elizabeth L. Doberman, Danielle J. D’Souza, Karen Fine, Derek M. Garibaldi, Brian T. Gehrie, Eric A. Golden, Sherita H. Gurses, Ayse P. Hill, Peter M. Hughes, Mark T. Kahn, Jeffrey P. Koch, Colleen G. Marx, Jason J. Meisenberg, Barry R. Natterman, Jeffrey Rushton, Cynda H. Sapirstein, Adam Selinger, Stephen R. Stephens, R. Scott Toner, Eric S. Unguru, Yoram van Stone, Maureen Kachalia, Allen |
author_sort | Ehmann, Michael R. |
collection | PubMed |
description | The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium—with diverse expertise and representation—representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process that determined the values and moral reference points of citizens and health-care professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens’ values and by general expert consensus. Allocation schema for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource’s varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing health-care resources during public health catastrophes. |
format | Online Article Text |
id | pubmed-7521357 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | American College of Chest Physicians. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-75213572020-09-29 Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis Ehmann, Michael R. Zink, Elizabeth K. Levin, Amanda B. Suarez, Jose I. Belcher, Harolyn M.E. Daugherty Biddison, Elizabeth L. Doberman, Danielle J. D’Souza, Karen Fine, Derek M. Garibaldi, Brian T. Gehrie, Eric A. Golden, Sherita H. Gurses, Ayse P. Hill, Peter M. Hughes, Mark T. Kahn, Jeffrey P. Koch, Colleen G. Marx, Jason J. Meisenberg, Barry R. Natterman, Jeffrey Rushton, Cynda H. Sapirstein, Adam Selinger, Stephen R. Stephens, R. Scott Toner, Eric S. Unguru, Yoram van Stone, Maureen Kachalia, Allen Chest Critical Care: How I Do It The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium—with diverse expertise and representation—representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process that determined the values and moral reference points of citizens and health-care professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens’ values and by general expert consensus. Allocation schema for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource’s varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing health-care resources during public health catastrophes. American College of Chest Physicians. Published by Elsevier Inc. 2021-03 2020-09-28 /pmc/articles/PMC7521357/ /pubmed/32991873 http://dx.doi.org/10.1016/j.chest.2020.09.246 Text en © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Critical Care: How I Do It Ehmann, Michael R. Zink, Elizabeth K. Levin, Amanda B. Suarez, Jose I. Belcher, Harolyn M.E. Daugherty Biddison, Elizabeth L. Doberman, Danielle J. D’Souza, Karen Fine, Derek M. Garibaldi, Brian T. Gehrie, Eric A. Golden, Sherita H. Gurses, Ayse P. Hill, Peter M. Hughes, Mark T. Kahn, Jeffrey P. Koch, Colleen G. Marx, Jason J. Meisenberg, Barry R. Natterman, Jeffrey Rushton, Cynda H. Sapirstein, Adam Selinger, Stephen R. Stephens, R. Scott Toner, Eric S. Unguru, Yoram van Stone, Maureen Kachalia, Allen Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis |
title | Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis |
title_full | Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis |
title_fullStr | Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis |
title_full_unstemmed | Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis |
title_short | Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis |
title_sort | operational recommendations for scarce resource allocation in a public health crisis |
topic | Critical Care: How I Do It |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521357/ https://www.ncbi.nlm.nih.gov/pubmed/32991873 http://dx.doi.org/10.1016/j.chest.2020.09.246 |
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