Special Populations

Dries, David J.; Reed, Mary Jane; Kissoon, Niranjan; Christian, Michael D.; Dichter, Jeffrey R.; Upperman, Jeffrey S.

doi:10.1378/chest.14-0737

Cited by 23 publications

(5 citation statements)

References 27 publications

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“…They identified 5 key elements for state CSC protocols (Table 1), 1,7 while in 2014, the CHEST Task Force Executive Committee identified 11 core topic areas (Table 2). 8 We used these criteria to evaluate state CSC plans. Our aim was not to criticize any plan, but to identify exemplars that can guide states and institutions as they develop their plans, especially if needed urgently.…”

mentioning

confidence: 99%

Allocation of Scarce Resources in a Pandemic: A Systematic Review of US State Crisis Standards of Care Documents

Romney

Fox

Carlson

et al. 2020

Disaster med. public health prep.

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The aim of this systematic review was to locate and analyze United States state crisis standards of care (CSC) documents to determine their prevalence and quality. Following PRISMA guidelines, Google search for "allocation of scarce resources" and "crisis standards of care (CSC)" for each state. We analyzed the plans based on the 2009 Institute of Medicine (IOM) report, which provided guidance for establishing CSC for use in disaster situations, as well as the 2014 CHEST consensus statement's 11 core topic areas. The search yielded 42 state documents, and we excluded 11 that were not CSC plans. Of the 31 included plans, 13 plans were written for an "all hazards" approach, while 18 were pandemic influenza specific. Eighteen had strong ethical grounding. Twenty-one plans had integrated and ongoing community and provider engagement, education, and communication. Twenty-two had assurances regarding legal authority and environment. Sixteen plans had clear indicators, triggers, and lines of responsibility. Finally, 28 had evidence-based clinical processes and operations. Five plans contained all 5 IOM elements: Arizona, Colorado, Minnesota, Nevada, and Vermont. Colorado and Minnesota have all hazards documents and processes for both adult and pediatric populations and could be considered exemplars for other states.

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mentioning

confidence: 99%

Allocation of Scarce Resources in a Pandemic: A Systematic Review of US State Crisis Standards of Care Documents

Romney

Fox

Carlson

et al. 2020

Disaster med. public health prep.

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“…Thus, rehabilitation needs and availability must be considered before initiating advanced intensive care support. 12–15 Although “dialyzer reuse protocols” have been useful during disasters such as the Haiti earthquake, this approach does not address the long-term needs of patients (see the “Special Populations” article by Dries et al 16 in this consensus statement).…”

Section: Resultsmentioning

confidence: 99%

Resource-Poor Settings: Response, Recovery, and Research

Geiling

Burkle

West

et al. 2014

Chest

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A lack of rudimentary ICU resources and capacity to enhance services plagues resource-poor or constrained settings. Capacity building therefore entails preventative strategies and strengthening of primary health services. Assistance from other countries and organizations is often needed to mount a surge response. Moreover, the disengagement of these responding groups and host country recovery require active planning. Future improvements in all phases require active research activities.

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“…Abstraction categories were developed based on a 2009 Institute of Medicine letter describing key elements of CSCs, recommendations from a 2014 CHEST task force on the provisions of care during pandemics, and the American Society of Clinical Oncology’s recent “Recommendations for the Oncology Community During the COVID-19 Pandemic.” Final categories included underlying ethical values and principles, health care scarce resource coverage, task force membership, allocation goals and methods, and disability rights. Categories were subdivided into quantitative fields (prespecified dichotomous or categorical abstractions) and qualitative fields (free text descriptions and/or exemplar quotes).…”

Section: Methodsmentioning

confidence: 99%

US State Government Crisis Standards of Care Guidelines

et al. 2021

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IMPORTANCE State crisis standards of care (CSC) guidelines in the US allocate scarce health care resources among patients. Anecdotal reports suggest that guidelines may disproportionately allocate resources away from patients with cancer, but no comprehensive evaluation has been performed. OBJECTIVE To examine the implications of US state CSC guidelines for patients with cancer, including allocation methods, cancer-related categorical exclusions and deprioritizations, and provisions for blood products and palliative care.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional population-based analysis examined state-endorsed CSC guidelines published before May 20, 2020, that included health care resource allocation recommendations. MAIN OUTCOMES AND MEASURESGuideline publication before or within 120 days after the first documented US case of coronavirus disease 2019 (COVID-19), inclusion of cancer-related categorical exclusions and/or deprioritizations, provisions for blood products and/or palliative care, and associations between these outcomes and state-based cancer demographics.RESULTS Thirty-one states had health care resource allocation guidelines that met inclusion criteria, of which 17 had been published or updated since the first US case of COVID-19. States whose available hospital bed capacity was predicted to exceed 100% at 6 months (χ 2 = 3.82; P = .05) or that had a National Cancer Institute-designated Comprehensive Cancer Center (CCC; χ 2 = 6.21; P = .01) were more likely to have publicly available guidelines. The most frequent primary methods of prioritization were the Sequential Organ Failure Assessment score (27 states [87%]) and deprioritizing persons with worse long-term prognoses (22 states [71%]). Seventeen states' (55%) allocation methods included cancer-related deprioritizations, and 8 states (26%) included cancer-related categorical exclusions. The presence of an in-state CCC was associated with lower likelihood of cancer-related categorical exclusions (multivariable odds ratio, 0.06 [95% CI, 0.004-0.87]). Guidelines with disability rights statements were associated with specific provisions to allocate blood products (multivariable odds ratio, 7.44 [95% CI,. Both the presence of an in-state CCC and having an oncologist and/or palliative care specialist on the state CSC task force were associated with the inclusion of palliative care provisions.CONCLUSIONS AND RELEVANCE Among states with CSC guidelines, most deprioritized some patients with cancer during resource allocation, and one-fourth categorically excluded them. The presence of an in-state CCC was associated with guideline availability, palliative care provisions, and lower odds of cancer-related exclusions. These data suggest that equitable state-level CSC considerations for patients with cancer benefit from the input of oncology stakeholders.

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Special Populations

Cited by 23 publications

References 27 publications

Allocation of Scarce Resources in a Pandemic: A Systematic Review of US State Crisis Standards of Care Documents

Allocation of Scarce Resources in a Pandemic: A Systematic Review of US State Crisis Standards of Care Documents

Resource-Poor Settings: Response, Recovery, and Research

US State Government Crisis Standards of Care Guidelines

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