Promoting equity with a multi-principle framework to allocate scarce ICU resources

Area of Science:

• Public Health Policy
• Critical Care Medicine
• Health Equity

Background:

• Intensive care unit (ICU) triage policies are crucial during pandemics for equitable resource allocation.
• Previous frameworks have been proposed to guide the distribution of scarce resources like ICU beds and ventilators.
• Concerns exist regarding potential biases in triage frameworks, particularly concerning racial disparities.

Purpose of the Study:

• To critically evaluate the characterization of the New Jersey (NJ) ICU allocation framework.
• To highlight the full scope of the NJ framework's criteria, including those promoting equity.
• To address claims that the NJ framework exacerbates disadvantage for Black patients.

Main Methods:

• Analysis of the NJ ICU allocation framework and its underlying principles.
• Comparison with a previously developed multi-principle allocation framework.
• Review of the stated and omitted criteria within the NJ framework.

Main Results:

• The NJ framework, modeled on a prior multi-principle approach, utilizes four allocation criteria.
• These criteria include survival chances, near-term prognosis, priority for frontline essential workers, and priority for younger patients.
• The omission of equity-promoting criteria in a critique is factually inaccurate and misrepresents the framework's potential impact.

Conclusions:

• The NJ ICU triage framework incorporates specific measures to promote equity.
• The critique mischaracterizes the framework by omitting key criteria.
• The acknowledged criteria in the NJ framework are designed to mitigate, rather than compound, racial disparities in critical care allocation.