Differences in US Regional Healthcare Allocation Guidelines During the COVID-19 Pandemic.

Area of Science:

• Public Health
• Medical Ethics
• Health Policy

Background:

• COVID-19 pandemic caused unprecedented resource scarcity in hospitals.
• This scarcity necessitated the development of crisis standards of care (CSC) guidelines.
• CSC involves significant changes in healthcare operations and care levels during emergencies.

Purpose of the Study:

• Examine the latest CSC guidelines in the western USA, focusing on ethical issues and health disparities.
• Analyze scarce resource allocation guidelines developed by healthcare systems and states.
• Assess the implementation and content of these critical guidelines.

Main Methods:

• Mixed-methods survey of physicians and ethicists involved in guideline development.
• Review of healthcare system and state-level scarce resource allocation guidelines.
• Study focused on the western region of the USA, including states that declared CSC.

Main Results:

• Most surveyed sites developed allocation guidelines, but only 40% were operationalized.
• Guidelines frequently included comorbidities (70%) and socioeconomic factors (50%), but rarely specific priority groups (10%).
• Tiebreakers included life cycle principles and random generators; some guidelines evolved to remove restrictions.

Conclusions:

• Scarce resource allocation guidelines are vital for clinicians during emergencies.
• Identified deficits and variations in guidelines risk perpetuating structural inequities and racism.
• Lack of regional agreement on transparent, justified standards can erode public trust and worsen inequity.