Triage Procedures for Critical Care Resource Allocation During Scarcity.
Triage Procedures for Critical Care Resource Allocation During Scarcity.
复制标题
稀缺期间重症监护资源分配的分类程序。
DOI：
10.1001/jamanetworkopen.2023.29688
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发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
Demartino, Erin S.
中科院分区：
文献类型：
--
作者：
Ennis, Jackson S.;Riggan, Kirsten A.;Nguyen, Nicholas V.;Kramer, Daniel B.;Smith, Alexander K.;Sulmasy, Daniel P.;Tilburt, Jon C.;Wolf, Susan M.;Demartino, Erin S.
How are comorbidities and prognosis relevant to state-level critical care triage procedures at times when resources are scarce? This cross-sectional analysis of 32 state-promulgated written triage procedures found that 20 states listed comorbidities that would restrict or preclude access to scarce resources, although conditions listed and proposed severity assessments differed by state. Twenty-one states also conditioned access on an estimation of length of life after hospital discharge. In this study, comorbidities and prognosis beyond hospital discharge frequently factored into triage procedures, restricting individuals from accessing critical care under conditions of scarcity in a pandemic. This cross-sectional study analyzes the role of comorbidities and long-term prognosis in state triage procedures. During the COVID-19 pandemic, many US states issued or revised pandemic preparedness plans guiding allocation of critical care resources during crises. State plans vary in the factors used to triage patients and have faced criticism from advocacy groups due to the potential for discrimination. To analyze the role of comorbidities and long-term prognosis in state triage procedures. This cross-sectional study used data gathered from parallel internet searches for state-endorsed pandemic preparedness plans for the 50 US states, District of Columbia, and Puerto Rico (hereafter referred to as states), which were conducted between November 25, 2021, and June 16, 2023. Plans available on June 16, 2023, that provided step-by-step instructions for triaging critically ill patients were categorized for use of comorbidities and prognostication. Prevalence and contents of lists of comorbidities and their stated function in triage and instructions to predict duration of postdischarge survival. Overall, 32 state-promulgated pandemic preparedness plans included triage procedures specific enough to guide triage in clinical practice. Twenty of these (63%) included lists of comorbidities that excluded (11 of 20 [55%]) or deprioritized (8 of 20 [40%]) patients during triage; one state’s list was formulated to resolve ties between patients with equal triage scores. Most states with triage procedures (21 of 32 [66%]) considered predicted survival beyond hospital discharge. These states proposed different prognostic time horizons; 15 of 21 (71%) were numeric (ranging from 6 months to 5 years after hospital discharge), with the remaining 6 (29%) using descriptive terms, such as long-term. In this cross-sectional study of state-promulgated critical care triage policies, most plans restricted access to scarce critical care resources for patients with listed comorbidities and/or for patients with less-than-average expected postdischarge survival. This analysis raises concerns about access to care during a public health crisis for populations with high burdens of chronic illness, such as individuals with disabilities and minoritized racial and ethnic groups.
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影响因子：
13.8
作者：
Miller WD;Han X;Peek ME;Charan Ashana D;Parker WF
通讯作者：
Parker WF
2018 年美国成年人多种慢性病的患病率。
影响因子：
5.5
作者：
Boersma P;Black LI;Ward BW
通讯作者：
Ward BW
DOI：
10.1377/hlthaff.2020.01452
发表时间：
2021-03
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Iezzoni LI;Rao SR;Ressalam J;Bolcic-Jankovic D;Agaronnik ND;Donelan K;Lagu T;Campbell EG
通讯作者：
Campbell EG
影响因子：
2.2
作者：
Jecker, Nancy S.
通讯作者：
Jecker, Nancy S.
影响因子：
2.9
作者：
Cooper, Sally-Ann;McLean, Gary;Morrison, Jill
通讯作者：
Morrison, Jill