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Racial Equity in Crisis Standards of Care—Reassuring Data or Reason for Concern?

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The coronavirus disease 2019 (COVID-19) pandemic has led to more than 956 000 hospitalizations in the United States as of February 5, 2021,1 bringing hospital systems close to exhausting available critical care resources during surges in infection rates. In an attempt to ensure the fair allocation of scarce resources, hospital systems have developed crisis standards of care (CSC) guidelines. Health equity experts have raised concerns that indiscriminate implementation of these guidelines will exacerbate racial and ability-based inequities that have plagued our current health care system. In their study, Gershengorn et al2 sought to determine whether the application of proposed CSC guidelines during a surge of COVID-19 cases at 2 urban hospitals in Miami, Florida, would be associated with an unanticipated increase in resource allocation disparities across race and ethnicity. Reviewing 5613 patient-days of data from 1127 patients who required or were at risk of requiring mechanical ventilation during admission at their hospitals, they found no association of race or ethnicity with the priority scores that guided their CSC resource allocation policy.

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Article Information

Published: March 19, 2021. doi:10.1001/jamanetworkopen.2021.4527

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Cleveland Manchanda EC et al. JAMA Network Open.

Corresponding Author: Emily C. Cleveland Manchanda, MD, MPH, Department of Emergency Medicine, Boston Medical Center, 800 Harrison Ave, BCD Bldg, First Floor, Boston, MA 02118 (emily.cleveland@bmc.org).

Conflict of Interest Disclosures: Dr Rodriguez reported having served on the Biden/Harris coronavirus disease 2019 advisory board. No other disclosures reported.

Additional Contributions: We are grateful to the many researchers, ethicists, clinicians, and advocates who have dedicated their energy to ensuring that crisis standards of care equitably safeguard our health system’s resources.

References
1.
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2.
Gershengorn  HB , Holt  GE , Rezk  A ,  et al.  Assessment of disparities associated with a crisis standards of care resource allocation algorithm for patients in 2 US hospitals during the COVID-19 pandemic.   JAMA Netw Open. 2021;4(3):e214149. doi:10.1001/jamanetworkopen.2021.4149Google Scholar
3.
Tai  DBG , Shah  A , Doubeni  CA , Sia  IG , Wieland  ML .  The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States.   Clin Infect Dis. Published online June 20, 2020. doi:10.1093/cid/ciaa815Google Scholar
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Bravata  DM , Perkins  AJ , Myers  LJ ,  et al.  Association of intensive care unit patient load and demand with mortality rates in US Department of Veterans Affairs hospitals during the COVID-19 pandemic.   JAMA Netw Open. 2021;4(1):e2034266. doi:10.1001/jamanetworkopen.2020.34266PubMedGoogle Scholar
5.
Miller  WD , Peek  ME , Parker  WF .  Scarce resource allocation scores threaten to exacerbate racial disparities in health care.   Chest. 2020;158(4):1332-1334. doi:10.1016/j.chest.2020.05.526PubMedGoogle ScholarCrossref
6.
Cleveland Manchanda  EC , Sanky  C , Appel  JM .  Crisis standards of care in the USA: a systematic review and implications for equity amidst COVID-19.   J Racial Ethn Health Disparities. Published online August 13, 2020. doi:10.1007/s40615-020-00840-5Google Scholar
7.
Piscitello  GM , Kapania  EM , Miller  WD , Rojas  JC , Siegler  M , Parker  WF .  Variation in ventilator allocation guidelines by US state during the coronavirus disease 2019 pandemic: a systematic review.   JAMA Netw Open. 2020;3(6):e2012606. doi:10.1001/jamanetworkopen.2020.12606PubMedGoogle Scholar
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