Assessment of Disparities Associated With a Crisis Standards of Care Resource Allocation Algorithm for Patients in 2 US Hospitals During the COVID-19 Pandemic.
Assessment of Disparities Associated With a Crisis Standards of Care Resource Allocation Algorithm for Patients in 2 US Hospitals During the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2021.4149
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发表时间：
2021-03-01
影响因子：
13.8
通讯作者：
Brosco JP
中科院分区：
文献类型：
--
作者：
Gershengorn HB;Holt GE;Rezk A;Delgado S;Shah N;Arora A;Colucci LB;Mora B;Iyengar RS;Lopez A;Martinez BM;West J;Goodman KW;Kett DH;Brosco JP
Is there an association of race and/or ethnicity with priority scores based on both short-term and longer-term estimated mortality used for resource allocation under crisis standards of care? In this retrospective cohort study of 1127 patients with 5613 patient-days in 2 US hospitals, there was no significant association of race or ethnicity with priority score. In this study, the use of a crisis standards of care resource allocation policy based on both short-term and longer-term estimated mortality did not appear to discriminate against hospitalized patients based on self-identified race or ethnicity. This cohort study evaluates whether unanticipated disparities by race or ethnicity would arise from the use of a resource allocation policy during the coronavirus disease 2019 (COVID-19) pandemic. Significant concern has been raised that crisis standards of care policies aimed at guiding resource allocation may be biased against people based on race/ethnicity. To evaluate whether unanticipated disparities by race or ethnicity arise from a single institution’s resource allocation policy. This cohort study included adults (aged ≥18 years) who were cared for on a coronavirus disease 2019 (COVID-19) ward or in a monitored unit requiring invasive or noninvasive ventilation or high-flow nasal cannula between May 26 and July 14, 2020, at 2 academic hospitals in Miami, Florida. Race (ie, White, Black, Asian, multiracial) and ethnicity (ie, non-Hispanic, Hispanic). The primary outcome was based on a resource allocation priority score (range, 1-8, with 1 indicating highest and 8 indicating lowest priority) that was assigned daily based on both estimated short-term (using Sequential Organ Failure Assessment score) and longer-term (using comorbidities) mortality. There were 2 coprimary outcomes: maximum and minimum score for each patient over all eligible patient-days. Standard summary statistics were used to describe the cohort, and multivariable Poisson regression was used to identify associations of race and ethnicity with each outcome. The cohort consisted of 5613 patient-days of data from 1127 patients (median [interquartile range {IQR}] age, 62.7 [51.7-73.7]; 607 [53.9%] men). Of these, 711 (63.1%) were White patients, 323 (28.7%) were Black patients, 8 (0.7%) were Asian patients, and 31 (2.8%) were multiracial patients; 480 (42.6%) were non-Hispanic patients, and 611 (54.2%) were Hispanic patients. The median (IQR) maximum priority score for the cohort was 3 (1-4); the median (IQR) minimum score was 2 (1-3). After adjustment, there was no association of race with maximum priority score using White patients as the reference group (Black patients: incidence rate ratio [IRR], 1.00; 95% CI, 0.89-1.12; Asian patients: IRR, 0.95; 95% CI. 0.62-1.45; multiracial patients: IRR, 0.93; 95% CI, 0.72-1.19) or of ethnicity using non-Hispanic patients as the reference group (Hispanic patients: IRR, 0.98; 95% CI, 0.88-1.10); similarly, no association was found with minimum score for race, again with White patients as the reference group (Black patients: IRR, 1.01; 95% CI, 0.90-1.14; Asian patients: IRR, 0.96; 95% CI, 0.62-1.49; multiracial patients: IRR, 0.81; 95% CI, 0.61-1.07) or ethnicity, again with non-Hispanic patients as the reference group (Hispanic patients: IRR, 1.00; 95% CI, 0.89-1.13). In this cohort study of adult patients admitted to a COVID-19 unit at 2 US hospitals, there was no association of race or ethnicity with the priority score underpinning the resource allocation policy. Despite this finding, any policy to guide altered standards of care during a crisis should be monitored to ensure equitable distribution of resources.
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影响因子：
7.9
作者：
Grover, Simmy;McClelland, Alastair;Furnham, Adrian
通讯作者：
Furnham, Adrian
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Vigil JM;Coulombe P;Alcock J;Kruger E;Stith SS;Strenth C;Parshall M;Cichowski SB
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Cichowski SB
DOI：
10.1007/s40615-020-00844-1
发表时间：
2020-08-13
影响因子：
3.9
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通讯作者：
Arasteh, Kamyar
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5.6
作者：
Holtgrave, David R.;Barranco, Meredith A.;Rosenberg, Eli S.
通讯作者：
Rosenberg, Eli S.
影响因子：
33.9
作者：
Killerby, Marie E.;Link-Gelles, Ruth;Tate, Jacqueline E.
通讯作者：
Tate, Jacqueline E.