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Health Policy

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

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JAMA Network Open

Published Online: March 19, 2021

Invited Commentary

Article Information and Disclosures

Emily C. Cleveland Manchanda, MD, MPH^1,2;

Melanie F. Molina, MD³;

Robert M. Rodriguez, MD⁴

Author Affiliations

¹Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
²Boston University School of Medicine, Boston, Massachusetts
³Department of Emergency Medicine, Massachusetts General Hospital, Boston
⁴Department of Emergency Medicine, University of California, San Francisco

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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

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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/s40615-020-00840-5 Google Scholar

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.2020.12606 PubMed Google Scholar

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
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