Heterogeneity in US pandemic allocation policies: state-to-state variation, stakeholder insights and implications for older Americans

美国大流行分配政策的异质性：州与州之间的差异、利益相关者的见解以及对美国老年人的影响

• 批准号: 10300747
• 负责人: Erin S DeMartino
• 金额: $ 15.9万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10300747
• 关键词: Accounting; Admission activity; Adult; Age; Age Factors; Aging; American; Atlases; Award; Beds; Bioethics; COVID-19; COVID-19 mortality; COVID-19 pandemic; Caring; Categories; Centers for Disease Control and Prevention (U.S.); Cessation of life; Civil Rights; Clinical; Coupled; Critical Care; Critical Illness; Data; Dementia; Development; Diagnosis; Disabled Persons; Disadvantaged; Discrimination; District of Columbia; Elderly; Ethics; Exclusion; Exclusion Criteria; Face; Future; Generations; Goals; Guidelines; Health; Health Policy; Health system; Heterogeneity; Individual; Intensive Care; Intensive Care Units; Intervention; Interview; Investigation; Knowledge; Life; Life Expectancy; Measures; Medicare; Methodology; Methods; Minority; Morbidity - disease rate; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Physicians; Policies; Policy Analysis; Policy Developments; Population; Population Density; Prevalence; Principal Investigator; Process; Qualitative Methods; Rehabilitation therapy; Reporting; Research; Research Personnel; Resource Allocation; Resources; Risk; Role; Savings; Severity of illness; Societies; Structure; Triage; Variant; Ventilator; Work; base; beneficiary; burden of illness; career; career development; cognitive disability; comorbidity; cost; disability; experience; geographic population; health service use; high risk; human old age (65+); insight; lens; multidisciplinary; novel; older patient; pandemic disease; skills; stakeholder perspectives; systematic review

ABSTRACT Even before 2020, older Americans made up the majority of ICU admissions and deaths. In 2020, as a pandemic infiltrates every corner of the globe, older adults are disproportionately impacted, facing greater morbidity and mortality from COVID-19 than any other segment of the population. As a society we are tackling unsettled questions about how best to deploy limited resources as we confront mass critical illness on a scale not seen for generations. These questions strike at the core of our ethos as a nation, challenging us to craft policies to sort through waves of patients, knowing that if crisis standards of care are enacted those policies will determine who is allocated intensive care resources – and who is not. In Aim 1 we propose to analyze states’ scarce resource allocation policies through an anti- discrimination lens, seeking to characterize the ways in which policies explicitly or implicitly disadvantage older or disabled persons. These may include consideration of advanced age or disability as an initial exclusion or deprioritization criterion, or as a tiebreaker among patients presenting with similar severity of illness. We then seek in Aim 2 to measure the size of the American population at highest risk to suffer from such criteria, Medicare beneficiaries with two or more comorbid conditions living in jurisdictions that factor age and disability into allocation decisions. In Aim 3 we will contextualize our findings with in-depth interviews with policy authors from states with varied approaches to age and disability in triage. This pilot research will lay evidentiary groundwork for future policy reform, characterizing the permutations and pervasiveness of discriminatory policies against older adults and persons living with disability. During the award period the principal investigator, who is a critical care physician, will acquire skills in qualitative methods and layer policy findings over summary claims data, a methodology she intends to further explore in future career development mechanisms. The proposed projects will serve as a first step in the candidate’s trajectory toward an independent research career at the intersection of bioethics, critical care, health policy and aging research.

摘要 即使在2020年之前，美国老年人也占ICU入院和死亡人数的大多数。在 2020年，随着大流行病渗透到地球仪的每个角落，老年人不成比例地 受影响，面临着比世界上任何其他地区更高的COVID-19发病率和死亡率， 人口作为一个社会，我们正在解决如何最好地部署有限的 在我们面对几代人从未见过的大规模危急疾病时，我们需要更多的资源。这些 这些问题冲击着我们作为一个国家的民族精神的核心，挑战着我们制定政策， 通过一波又一波的病人，他们知道，如果制定了危机护理标准，这些政策将 决定谁被分配重症监护资源-谁没有。 在目标1中，我们建议通过反 歧视的透镜，试图描述政策明示或暗示 使老年人或残疾人处于不利地位。这些可能包括考虑到高龄或 残疾作为初始排除或降低优先级的标准，或作为患者之间的决定因素 表现出相似的疾病严重程度然后，我们在目标2中寻求测量 美国人口在最高的风险遭受这样的标准，医疗保险受益人与两个 或生活在将年龄和残疾因素纳入分配的司法管辖区的更多共病状况 决策在目标3中，我们将通过与政策制定者的深入访谈，将我们的发现置于背景中 来自各州，对年龄和残疾的分类方法各不相同。 这项试点研究将为今后的政策改革奠定证据基础， 针对老年人和老年人的歧视性政策的排列和普遍性 生活在残疾中。在授予期间，主要研究者，谁是一个关键的照顾 医生，将获得定性方法的技能，并将政策发现置于总结之上 索赔数据，她打算在未来的职业发展中进一步探索这种方法 机制等所提出的项目将作为候选人走向 在生物伦理学，重症监护，卫生政策和 老化研究