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.

抽象的 甚至在 2020 年之前，美国老年人就占 ICU 入院和死亡人数的大部分。 2020年，随着一场大流行病渗透到全球各个角落，老年人不成比例地 受到影响，与任何其他领域相比，COVID-19 的发病率和死亡率更高 作为一个社会，我们正在协商如何最好地部署有限的人口。 当我们面临数代人未曾见过的大规模危重疾病时，我们需要资源。 问题触及我们作为一个国家的核心精神，挑战我们制定政策来解决问题 通过一波又一波的患者，知道如果颁布危机护理标准，这些政策将 确定谁被分配重症监护资源，谁不被分配。 在目标 1 中，我们建议通过反面分析国家的稀缺资源配置政策。 歧视视角，试图描述政策明示或暗示的方式 对老年人或残疾人不利的因素可能包括考虑年老或 残疾作为最初的排除或优先考虑标准，或作为患者之间的决胜局 然后，我们在目标 2 中寻求测量相似严重程度的疾病的大小。 美国人口遭受此类标准的风险最高，医疗保险受益人有两个 或更多合并症居住在将年龄和残疾纳入分配的司法管辖区 在目标 3 中，我们将通过对政策作者的深入访谈来阐述我们的发现。 来自对年龄和残疾分类采取不同方法的州。 这项试点研究将为未来的政策改革奠定证据基础， 针对老年人和个人的歧视政策的排列和普遍性 在奖励期间，首席研究员是一名重症监护人员。 医生，将获得定性方法的技能，并将政策结果分层总结 索赔数据，她打算在未来职业发展中进一步探索的方法论 拟议的项目将作为候选人走向发展轨迹的第一步。 在生物伦理学、重症监护、卫生政策和 衰老研究。