Evidence map›Paper›PMID 32991873›Full record

ArticleChest2021

Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis.

Michael R Ehmann, Elizabeth K Zink, Amanda B Levin, Jose I Suarez, Harolyn M E Belcher, Elizabeth L Daugherty Biddison, Danielle J Doberman, Karen D'Souza, Derek M Fine, Brian T Garibaldi and 18 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Chest, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  13. Comparison of Six Scoring Systems for Predicting In-hospital Mortality among Patients with SARS-COV2 Presenting to the Emergency Department.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors.

Michael R EhmannDepartment of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Elizabeth K ZinkDepartment of Neurology, Johns Hopkins University, Baltimore, MD; Department of Neuroscience Nursing, The Johns Hopkins Hospital, Baltimore, MD.
Amanda B LevinDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
Jose I SuarezDepartment 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.
Harolyn M E BelcherDepartment of Pediatrics, Johns Hopkins University, Baltimore, MD; Center for Diversity in Public Health Leadership Training, Kennedy Krieger Institute, Baltimore, MD.
Elizabeth L Daugherty BiddisonDepartment of Medicine, Johns Hopkins University, Baltimore, MD.
Danielle J DobermanDepartment of Medicine, Johns Hopkins University, Baltimore, MD.
Karen D'SouzaArmstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD.
Derek M FineDepartment of Medicine, Johns Hopkins University, Baltimore, MD.
Brian T GaribaldiDepartment of Medicine, Johns Hopkins University, Baltimore, MD; Department of Physiology, Johns Hopkins University, Baltimore, MD.
Eric A GehrieDepartment of Pathology, Johns Hopkins University, Baltimore, MD; Department of Surgery, Johns Hopkins University, Baltimore, MD.
Sherita H GoldenDepartment 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, Baltimore, MD.
Ayse P GursesDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD.
Peter M HillDepartment of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Mark T HughesDepartment of Medicine, Johns Hopkins University, Baltimore, MD; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD.
Jeffrey P KahnBerman Institute of Bioethics, Johns Hopkins University, Baltimore, MD.
Colleen G KochDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
Jason J MarxDepartment of Medicine, University of Maryland St Joseph Medical Center, University of Maryland Medical System, Towson, MD.
Barry R MeisenbergDepartment of Medicine, Anne Arundel Medical Center, Annapolis, MD.
Jeffrey NattermanDepartment of Risk Management, The Johns Hopkins Hospital, Baltimore, MD.
Cynda H RushtonBerman Institute of Bioethics, Johns Hopkins University, Baltimore, MD; School of Nursing, Johns Hopkins University, Baltimore, MD.
Adam SapirsteinDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
Stephen R SelingerDepartment of Medicine, MedStar Franklin Square Medical Center, MedStar Harbor Hospital, Baltimore, MD.
R Scott StephensDepartment of Medicine, Johns Hopkins University, Baltimore, MD.
Eric S TonerJohns Hopkins Center for Health Security, Johns Hopkins University, Baltimore, MD.
Yoram UnguruDivision of Pediatric Hematology/Oncology, Sinai Hospital, Baltimore, MD.
Maureen van StoneDepartment of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore, MD.
Allen KachaliaDepartment of Medicine, Johns Hopkins University, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Electronic address: kachalia@jhu.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Indexed as

COVID-19Health Care RationingHealth WorkforceResource AllocationChange ManagementCivil DefenseDisaster PlanningHumansIntersectoral CollaborationMarylandPublic HealthSARS-CoV-2TriageCOVID-19disaster planninghealthcare rationingmedical ethicstriage

Identifiers

PMID32991873
PMCPMC7521357

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.