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1.
PLoS One ; 16(12): e0260798, 2021.
Article in English | MEDLINE | ID: covidwho-1599553

ABSTRACT

Despite remarkable academic efforts, why Enterprise Resource Planning (ERP) post-implementation success occurs still remains elusive. A reason for this shortage may be the insufficient addressing of an ERP-specific interior boundary condition, i.e., the multi-stakeholder perspective, in explaining this phenomenon. This issue may entail a gap between how ERP success is supposed to occur and how ERP success may actually occur, leading to theoretical inconsistency when investigating its causal roots. Through a case-based, inductive approach, this manuscript presents an ERP success causal network that embeds the overlooked boundary condition and offers a theoretical explanation of why the most relevant observed causal relationships may occur. The results provide a deeper understanding of the ERP success causal mechanisms and informative managerial suggestions to steer ERP initiatives towards long-haul success.


Subject(s)
Delivery of Health Care, Integrated/organization & administration , Efficiency, Organizational/standards , Financial Management, Hospital/methods , Health Care Rationing/standards , Health Resources/organization & administration , Hospital Information Systems/standards , Resource Allocation/methods , Humans , Planning Techniques , Software
3.
STAR Protoc ; 2(4): 100943, 2021 12 17.
Article in English | MEDLINE | ID: covidwho-1510407

ABSTRACT

During the COVID-19 pandemic, US states developed Crisis Standards of Care (CSC) algorithms to triage allocation of scarce resources to maximize population-wide benefit. While CSC algorithms were developed by ethical debate, this protocol guides their quantitative assessment. For CSC algorithms, this protocol addresses (1) adapting algorithms for empirical study, (2) quantifying predictive accuracy, and (3) simulating clinical decision-making. This protocol provides a framework for healthcare systems and governments to test the performance of CSC algorithms to ensure they meet their stated ethical goals. For complete details on the use and execution of this protocol, please refer to Jezmir et al. (2021).


Subject(s)
COVID-19/therapy , Critical Care/standards , Health Care Rationing/standards , Practice Guidelines as Topic/standards , Standard of Care/ethics , Triage/standards , COVID-19/virology , Critical Care/ethics , Health Care Rationing/ethics , Humans , SARS-CoV-2/isolation & purification , Triage/ethics , Triage/methods
4.
Chest ; 161(2): 504-513, 2022 02.
Article in English | MEDLINE | ID: covidwho-1401308

ABSTRACT

BACKGROUND: Faced with possible shortages due to COVID-19, many states updated or rapidly developed crisis standards of care (CSCs) and other pandemic preparedness plans (PPPs) for rationing resources, particularly ventilators. RESEARCH QUESTION: How have US states incorporated the controversial standard of rationing by age and/or life-years into their pandemic preparedness plans? STUDY DESIGN AND METHODS: This was an investigator-initiated, textual analysis conducted from April to June 2020, querying online resources and in-state contacts to identify PPPs published by each of the 50 states and for Washington, DC. Analysis included the most recent versions of CSC documents and official state PPPs containing triage guidance as of June 2020. Plans were categorized as rationing by (A) short-term survival (≤ 1 year), (B) 1 to 5 expected life-years, (C) total life-years, (D) "fair innings," that is, specific age cutoffs, or (O) other. The primary measure was any use of age and/or life-years. Plans were further categorized on the basis of whether age/life-years was a primary consideration. RESULTS: Thirty-five states promulgated PPPs addressing the rationing of critical care resources. Seven states considered short-term prognosis, seven considered whether a patient had 1 to 5 expected life-years, 13 rationed by total life-years, and one used the fair innings principle. Seven states provided only general ethical considerations. Seventeen of the 21 plans considering age/life-years made it a primary consideration. Several plans borrowed heavily from a few common sources, although use of terminology was inconsistent. Many documents were modified in light of controversy. INTERPRETATION: Guidance with respect to rationing by age and/or life-years varied widely. More than one-half of PPPs, many following a few common models, included age/life-years as an explicit rationing criterion; the majority of these made it a primary consideration. Terminology was often vague, and many plans evolved in response to pushback. These findings have ethical implications for the care of older adults and other vulnerable populations during a pandemic.


Subject(s)
COVID-19 , Civil Defense/standards , Crew Resource Management, Healthcare , Critical Care , Health Care Rationing/standards , Standard of Care/organization & administration , Triage , Aged , COVID-19/epidemiology , COVID-19/therapy , Crew Resource Management, Healthcare/ethics , Crew Resource Management, Healthcare/methods , Crew Resource Management, Healthcare/organization & administration , Critical Care/ethics , Critical Care/organization & administration , Critical Care/standards , Humans , SARS-CoV-2 , Surge Capacity/standards , Triage/ethics , Triage/organization & administration , Triage/standards , United States/epidemiology , Vulnerable Populations
5.
Am J Med ; 134(11): 1380-1388.e3, 2021 11.
Article in English | MEDLINE | ID: covidwho-1397151

ABSTRACT

BACKGROUND: Whether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions. METHODS: We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). RESULTS: There were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P trend = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03). CONCLUSIONS: An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.


Subject(s)
Bed Occupancy/statistics & numerical data , COVID-19 , Hospital Bed Capacity/statistics & numerical data , Intensive Care Units/statistics & numerical data , Mortality , Quality Improvement/organization & administration , COVID-19/mortality , COVID-19/therapy , Civil Defense , Health Care Rationing/organization & administration , Health Care Rationing/standards , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Outcome Assessment, Health Care , Registries , Risk Assessment , SARS-CoV-2 , Triage/organization & administration , United States/epidemiology
7.
PLoS One ; 16(6): e0253208, 2021.
Article in English | MEDLINE | ID: covidwho-1269921

ABSTRACT

BACKGROUND: Carceral facilities are epicenters of the COVID-19 pandemic, placing incarcerated people at an elevated risk of COVID-19 infection. Due to the initial limited availability of COVID-19 vaccines in the United States, all states have developed allocation plans that outline a phased distribution. This study uses document analysis to compare the relative prioritization of incarcerated people, correctional staff, and other groups at increased risk of COVID-19 infection and morbidity. METHODS AND FINDINGS: We conducted a document analysis of the vaccine dissemination plans of all 50 US states and the District of Columbia using a triple-coding method. Documents included state COVID-19 vaccination plans and supplemental materials on vaccine prioritization from state health department websites as of December 31, 2020. We found that 22% of states prioritized incarcerated people in Phase 1, 29% of states in Phase 2, and 2% in Phase 3, while 47% of states did not explicitly specify in which phase people who are incarcerated will be eligible for vaccination. Incarcerated people were consistently not prioritized in Phase 1, while other vulnerable groups who shared similar environmental risk received this early prioritization. States' plans prioritized in Phase 1: prison and jail workers (49%), law enforcement (63%), seniors (65+ years, 59%), and long-term care facility residents (100%). CONCLUSIONS: This study demonstrates that states' COVID-19 vaccine allocation plans do not prioritize incarcerated people and provide little to no guidance on vaccination protocols if they fall under other high-risk categories that receive earlier priority. Deprioritizing incarcerated people for vaccination misses a crucial opportunity for COVID-19 mitigation. It also raises ethical and equity concerns. As states move forward with their vaccine distribution, further work must be done to prioritize ethical allocation and distribution of COVID-19 vaccines to incarcerated people.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Health Care Rationing/organization & administration , Prisoners/statistics & numerical data , Vaccination/standards , Age Factors , Aged , COVID-19/epidemiology , COVID-19/transmission , Family , Health Care Rationing/standards , Humans , Middle Aged , Pandemics/prevention & control , Police/statistics & numerical data , Risk Factors , United States/epidemiology , Vulnerable Populations/statistics & numerical data
8.
Hastings Cent Rep ; 51(3): 3-4, 2021 May.
Article in English | MEDLINE | ID: covidwho-1239985

ABSTRACT

The Covid-19 pandemic has exposed four myths in bioethics. First, the flood of bioethics publications on how to allocate scarce resources in crisis conditions has assumed authorities would declare the onset of crisis standards of care, yet few have done so. This leaves guidelines in limbo and patients unprotected. Second, the pandemic's realities have exploded traditional boundaries between clinical, research, and public health ethics, requiring bioethics to face the interdigitation of learning, doing, and allocating. Third, without empirical research, the success or failure of ethics guidelines remains unknown, demonstrating that crafting ethics guidance is only the start. And fourth, the pandemic's glaring health inequities require new commitment to learn from communities facing extraordinary challenges. Without that new learning, bioethics methods cannot succeed. The pandemic is a wake-up call, and bioethics must rise to the challenge.


Subject(s)
Bioethical Issues/standards , COVID-19/epidemiology , Health Care Rationing/organization & administration , Biomedical Research/ethics , Biomedical Research/organization & administration , Health Care Rationing/ethics , Health Care Rationing/standards , Health Status Disparities , Healthcare Disparities/ethics , Healthcare Disparities/standards , Humans , Pandemics , Public Health , SARS-CoV-2
9.
Hastings Cent Rep ; 51(3): 27-36, 2021 May.
Article in English | MEDLINE | ID: covidwho-1210655

ABSTRACT

This article sets forth a solidaristic approach to global distribution of vaccines against the SARS-CoV-2 virus. Our approach draws inspiration from African ethics and from the characterization of the Covid-19 crisis as a syndemic, a convergence of biosocial forces that interact with one another to produce and exacerbate clinical disease and prognosis. The first section elaborates the twin ideas of syndemic and solidarity. The second section argues that these ideas lend support to global health alliances to distribute vaccines beyond national borders. The third section introduces ethical criteria to guide global distribution, emphasizing priority to low- and middle-income countries, which have the least ability to obtain vaccines on their own. It also justifies giving priority to people at high risk of infection and high risk of severe disease and death.


Subject(s)
COVID-19 Vaccines/supply & distribution , COVID-19/epidemiology , COVID-19/prevention & control , Health Care Rationing/organization & administration , International Cooperation , Africa , Developing Countries , Health Care Rationing/standards , Humans , SARS-CoV-2 , Social Justice , Syndemic
14.
Recenti Prog Med ; 112(3): 167-170, 2021 03.
Article in Italian | MEDLINE | ID: covidwho-1123705

ABSTRACT

For covid-19, a disease that has proved fatal in many cases, a specific therapy has not yet been found, but the vaccine. This has triggered a further series of issues. Who to vaccinate first, how to achieve the so-called "herd immunity", especially if it is right, as it is being done, start with the medical staff and immediately after safeguard the elderly which also involve the problem of a clear explanation and acceptance, through informed consent, which it can be particularly difficult to illustrate.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Health Care Rationing , SARS-CoV-2/immunology , Aged , COVID-19 Vaccines/supply & distribution , Health Care Rationing/ethics , Health Care Rationing/standards , Health Personnel , Health Priorities , Health Services Needs and Demand , Human Rights , Humans , Immunity, Herd , Occupational Exposure , Right to Health , Social Justice , Vaccination
17.
Am Psychol ; 76(3): 451-461, 2021 04.
Article in English | MEDLINE | ID: covidwho-1065804

ABSTRACT

The health threat posed by the novel coronavirus that caused the COVID-19 pandemic has particular implications for people with disabilities, including vulnerability to exposure and complications, and concerns about the role of ableism in access to treatment and medical rationing decisions. Shortages of necessary medical equipment to treat COVID-19 have prompted triage guidelines outlining the ways in which lifesaving equipment, such as mechanical ventilators and intensive care unit beds, may need to be rationed among affected individuals. In this article, we explore the realities of medical rationing, and various approaches to triage and prioritization. We discuss the psychology of ableism, perceptions about quality of life, social determinants of health, and how attitudes toward disability can affect rationing decisions and access to care. In addition to the grassroots advocacy and activism undertaken by the disability community, psychology is rich in its contributions to the role of attitudes, prejudice, and discriminatory behavior on the social fabric of society. We call on psychologists to advocate for social justice in pandemic preparedness, promote disability justice in health care settings, call for transparency and accountability in rationing approaches, and support policy changes for macro- and microallocation strategies to proactively reduce the need for rationing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19/therapy , Clinical Decision-Making , Disabled Persons , Health Care Rationing , Health Knowledge, Attitudes, Practice , Social Determinants of Health , Social Justice , Triage , Clinical Decision-Making/ethics , Health Care Rationing/ethics , Health Care Rationing/standards , Humans , Social Determinants of Health/ethics , Social Determinants of Health/standards , Social Justice/ethics , Social Justice/standards , Triage/ethics , Triage/standards
19.
Lancet Respir Med ; 9(4): 430-434, 2021 04.
Article in English | MEDLINE | ID: covidwho-1033502

ABSTRACT

The COVID-19 pandemic strained health-care systems throughout the world. For some, available medical resources could not meet the increased demand and rationing was ultimately required. Hospitals and governments often sought to establish triage committees to assist with allocation decisions. However, for institutions operating under crisis standards of care (during times when standards of care must be substantially lowered in the setting of crisis), relying on these committees for rationing decisions was impractical-circumstances were changing too rapidly, occurring in too many diverse locations within hospitals, and the available information for decision making was notably scarce. Furthermore, a utilitarian approach to decision making based on an analysis of outcomes is problematic due to uncertainty regarding outcomes of different therapeutic options. We propose that triage committees could be involved in providing policies and guidance for clinicians to help ensure equity in the application of rationing under crisis standards of care. An approach guided by egalitarian principles, integrated with utilitarian principles, can support physicians at the bedside when they must ration scarce resources.


Subject(s)
COVID-19/therapy , Critical Care/organization & administration , Health Care Rationing/organization & administration , Pandemics/prevention & control , Triage/organization & administration , Advisory Committees/organization & administration , Advisory Committees/standards , COVID-19/epidemiology , Critical Care/economics , Critical Care/standards , Critical Care/statistics & numerical data , Decision Making, Organizational , Global Health/economics , Global Health/standards , Health Care Rationing/economics , Health Care Rationing/standards , Health Policy , Humans , Intersectoral Collaboration , Pandemics/economics , Practice Guidelines as Topic , Standard of Care/economics , Triage/standards
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