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Improving the efficiency and equity of critical care allocation during a crisis with place-based disadvantage indices

Award Number: R01LM014263
ORGANIZATION: NATIONAL LIBRARY OF MEDICINE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 04/01/2023
PERIOD OF PERFORMANCE END DATE: 01/31/2028

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Improving the efficiency and equity of critical care allocation during a crisis with place-based disadvantage indices - When a US hospital system is overwhelmed by disaster, Crisis Standards of Care guide the triage teams forced to choose which patients receive scarce life support treatments. Analogous to an organ allocation system, these algorithms convert ethical principles into a concrete rank ordering of candidates for Intensive Care Unit (ICU) treatments with life support allocation scores. Disasters that produce scarcity tend to fall hardest on specific geographical areas and communities. When designing algorithms to allocate scarce life support, public health officials should take this context into account. In an attempt to identify the critically ill patients with the highest likelihood of benefit from treatment, most US states would prioritize those with low Sequential Organ Failure Assessment (SOFA) scores. But SOFA was designed for patients already on life support in the ICU, using routinely measured laboratory values, drug doses, and vital signs to monitor response to treatment. Most patients have low SOFA scores when critical illness is first recognized, and SOFA cannot accurately predict the risk of death using data before life support was allocated. We demonstrated how the poor predictive performance of SOFA-based triage protocols is partially explained by a miscalibrated renal component of the SOFA score. There is a clear need to develop and validate a novel life support allocation protocol designed to debias existing scores and save more lives. Place-based disadvantage indices, such as the Area Deprivation Index (ADI) and the Social Vulnerability Index, offer a potential solution. Using these validated geographical measures of neighborhood deprivation to allocate scarce healthcare resources counteracts the geographic concentration of the disaster. We hypothesize that a well-designed life support allocation score using place-based disadvantage indices can save more lives. The overall objective of this project is to develop a life support allocation algorithm that accurately and equitably allocates scarce ICU treatments in a crisis. In Aim 1, we will use structural equation modeling to create an Equitable Life Support Allocation (ELSA) score, using place-based disadvantage indices to debias SOFA. In Aim 2, develop the ICU Crisis Simulation Model (ICSM), a discrete event simulation that models patient flow and survival, as a testing and evaluation environment for life support allocation protocols. In Aim 3, we will externally validate ELSA and ICSM in the National COVID Cohort Collaborative Data Enclave, which currently contains geocoded records from 14 million patients from 74 sites. Our project will address one of the most pressing challenges in applied public health ethics, producing 1) an empirically derived score to distribute life support more accurately and equitably in a crisis and 2) open-source simulation software to evaluate the efficiency and equity of life support allocation protocols.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $539,207 )
2025	2025	UNIVERSITY OF CHICAGO	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Medical Library Assistance	001	3	7/30/2025	NON-COMPETING CONTINUATION	$53,921
2025	2025	UNIVERSITY OF CHICAGO	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Medical Library Assistance	000	3	1/15/2025	NON-COMPETING CONTINUATION	$485,286
														Subtotal = $539,207

Issue Date FY: 2024 ( Subtotal = $476,533 )
2024	2024	UNIVERSITY OF CHICAGO	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Medical Library Assistance	001	2	4/30/2024	NON-COMPETING CONTINUATION	$47,653
2024	2024	UNIVERSITY OF CHICAGO	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Medical Library Assistance	000	2	1/31/2024	NON-COMPETING CONTINUATION	$428,880
														Subtotal = $476,533

Issue Date FY: 2023 ( Subtotal = $483,503 )
2023	2023	UNIVERSITY OF CHICAGO	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Medical Library Assistance	000	1	3/30/2023	NEW	$483,503
														Subtotal = $483,503

Grand Total All Awards = $1,499,243

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Improving the efficiency and equity of critical care allocation during a crisis with place-based disadvantage indices

Award Number: R01LM014263

ORGANIZATION: NATIONAL LIBRARY OF MEDICINE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 04/01/2023

PERIOD OF PERFORMANCE END DATE: 01/31/2028

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