The healthcare field is struggling with urgent questions about how to respond to the current COVID-19 pandemic. Health systems, clinicians, policymakers, and the general public want evidence to inform critical decisions. In this period of clinical uncertainty, the AHRQ Evidence-based Practice Center (EPC) Program has rapidly summarized the current available evidence in response to urgent questions about promising options to control the COVID-19 pandemic.
The EPC Program identified a 2012 evidence report that could help the healthcare field care for patients during this global pandemic. Because this review, "Allocation of Scarce Resources in a Mass Casualty Event," was developed before the COVID-19 pandemic, the EPC Program has commissioned a targeted update as a rapid evidence product.
- When decision makers need to make difficult choices regarding the allocation of scarce resources and pandemic response, potential strategies include:
- reducing demand for health care services through medical countermeasures (e.g., mass vaccination) or non-pharmaceutical interventions (e.g., social distancing);
- optimizing existing resources (e.g., central command structure);
- augmenting resources (e.g., adding temporary facilities or personnel); and
- implementing crisis standards of care.
- We identified 201 studies from January 2011 through May 2020 evaluating resource allocation and pandemic response strategies addressed in infectious disease threats, natural disasters, terrorism, and other mass casualty events for decision makers. Research designs were observational, and critical appraisal results varied.
- Most research exists to reduce care demand (n=149); higher quality studies reported benefits of contact tracing, school closures, travel restrictions, port of entry screening, and mass vaccination. We identified 28 evaluations of strategies to augment resources; higher quality studies reported the effectiveness of establishing temporary facilities, using volunteers, and using decision support software. Strategies to optimize existing resources were assessed in 23 studies; higher quality studies reported successfully expanding scope of work and building on existing agreements between agencies. Few studies have evaluated crisis standards of care strategies. Coronavirus disease 2019 (COVID-19) research is emerging; four higher quality studies evaluated combinations of interventions; one reported the benefit of communitywide mask policies.
- Most existing research is based on simulations, and future research is needed to test strategies in practice.
Hempel S, Burke RV, Hochman M, et al. Allocation of scarce resources in a pandemic: rapid systematic review update of strategies for policy makers. JCE. 25 May 2021 [Epub ahead of print]. DOI: 10.1016/j.clinepi.2021.04.021.
Hempel S, Burke RV, Hochman M, Thompson G, Brothers A, Shin J, Motala A, Larkin J, Ringel J. Resource Allocation and Pandemic Response: An Evidence Synthesis To Inform Decision Making. (Prepared by the Southern California Evidence-based Practice Center under Contract No. 290-2015-00010-I). AHRQ Publication No. 20(21)-EHC027. Rockville, MD: Agency for Healthcare Research and Quality. October 2020. Posted final reports are located on the Effective Health Care Program search page. DOI: 10.23970/COVIDRESOURCE.