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

摘要 甚至在2020年前，老年美国人就占了ICU入院和死亡的大部分。在……里面 2020年，随着大流行渗透到全球的每一个角落，老年人不成比例地 受影响，面临着比其他地区更高的发病率和死亡率 人口。作为一个社会，我们正在处理尚未解决的问题，即如何最好地部署有限的 当我们面对几代人都没有见过的大规模危重疾病时，资源。这些 作为一个国家，问题直击我们精神的核心，挑战我们制定政策来分类 通过一波又一波的患者，知道如果危机护理标准得到实施，这些政策将 确定谁分配了重症监护资源，谁没有分配。 在目标1中，我们建议通过反分析来分析国家的稀缺资源分配政策 歧视镜头，试图刻画政策明示或隐含的方式 使老年人或残疾人处于不利地位。这些可能包括考虑高龄或 残疾作为最初的排斥或剥夺标准，或作为患者之间的决胜局 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 美国人口遭受此类标准的风险最高，联邦医疗保险受益人有两个 或生活在将年龄和残疾因素考虑到分配的司法管辖区的更多共病条件 决定。在目标3中，我们将通过对政策作者的深入采访来说明我们的发现 来自对年龄和残疾采取不同分类方法的州。 这项试点研究将为未来的政策改革奠定证据基础，表征 针对老年人和个人的歧视性政策的排列和普遍性 身患残疾的人。在获奖期间，首席调查员是危重护理人员 医生，将获得定性方法的技能，并将政策结果层次化，而不是摘要 申领数据，她打算在未来的职业发展中进一步探索一种方法 机械装置。提议的项目将是候选人实现以下目标的第一步 在生物伦理学、危重病护理、卫生政策和 老龄化研究。

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.