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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.
Afiliación
  • Ehmann MR; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
  • Zink EK; Department of Neurology, Johns Hopkins University, Baltimore, MD; Department of Neuroscience Nursing, The Johns Hopkins Hospital, Baltimore, MD.
  • Levin AB; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
  • Suarez JI; Department of Neurology, Johns Hopkins University, Baltimore, MD; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University, Baltimore, MD.
  • Belcher HME; Department of Pediatrics, Johns Hopkins University, Baltimore, MD; Center for Diversity in Public Health Leadership Training, Kennedy Krieger Institute, Baltimore, MD.
  • Daugherty Biddison EL; Department of Medicine, Johns Hopkins University, Baltimore, MD.
  • Doberman DJ; Department of Medicine, Johns Hopkins University, Baltimore, MD.
  • D'Souza K; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD.
  • Fine DM; Department of Medicine, Johns Hopkins University, Baltimore, MD.
  • Garibaldi BT; Department of Medicine, Johns Hopkins University, Baltimore, MD; Department of Physiology, Johns Hopkins University, Baltimore, MD.
  • Gehrie EA; Department of Pathology, Johns Hopkins University, Baltimore, MD; Department of Surgery, Johns Hopkins University, Baltimore, MD.
  • Golden SH; Department of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins University, Baltimore, MD; Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine,
  • Gurses AP; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD.
  • Hill PM; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
  • Hughes MT; Department of Medicine, Johns Hopkins University, Baltimore, MD; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD.
  • Kahn JP; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD.
  • Koch CG; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
  • Marx JJ; Department of Medicine, University of Maryland St Joseph Medical Center, University of Maryland Medical System, Towson, MD.
  • Meisenberg BR; Department of Medicine, Anne Arundel Medical Center, Annapolis, MD.
  • Natterman J; Department of Risk Management, The Johns Hopkins Hospital, Baltimore, MD.
  • Rushton CH; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD; School of Nursing, Johns Hopkins University, Baltimore, MD.
  • Sapirstein A; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
  • Selinger SR; Department of Medicine, MedStar Franklin Square Medical Center, MedStar Harbor Hospital, Baltimore, MD.
  • Stephens RS; Department of Medicine, Johns Hopkins University, Baltimore, MD.
  • Toner ES; Johns Hopkins Center for Health Security, Johns Hopkins University, Baltimore, MD.
  • Unguru Y; Division of Pediatric Hematology/Oncology, Sinai Hospital, Baltimore, MD.
  • van Stone M; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore, MD.
  • Kachalia A; Department of Medicine, Johns Hopkins University, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Electronic address: kachalia@jhu.edu.
Chest ; 159(3): 1076-1083, 2021 03.
Article en En | MEDLINE | ID: mdl-32991873
ABSTRACT
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Asignación de Recursos para la Atención de Salud / Salud Pública / Defensa Civil / Asignación de Recursos / COVID-19 / Fuerza Laboral en Salud Tipo de estudio: Guideline Aspecto: Determinantes_sociais_saude / Ethics Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Chest Año: 2021 Tipo del documento: Article País de afiliación: Moldova
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Asignación de Recursos para la Atención de Salud / Salud Pública / Defensa Civil / Asignación de Recursos / COVID-19 / Fuerza Laboral en Salud Tipo de estudio: Guideline Aspecto: Determinantes_sociais_saude / Ethics Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Chest Año: 2021 Tipo del documento: Article País de afiliación: Moldova