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Racial bias is associated with the allocation of advanced heart failure therapies, heart transplants, and ventricular assist devices. It is unknown whether gender and racial biases are associated with the allocation of advanced therapies among women. To determine whether the intersection of patient gender and race is associated with the decision-making of clinicians during the allocation of advanced heart failure therapies. In this qualitative study, 46 US clinicians attending a conference for an international heart transplant organization in April 2019 were interviewed on the allocation of advanced heart failure therapies. Participants were randomized to examine clinical vignettes that varied 1:1 by patient race (African American to white) and 20:3 by gender (women to men) to purposefully target vignettes of women patients to compare with a prior study of vignettes of men patients. Participants were interviewed about their decision-making process using the think-aloud technique and provided supplemental surveys. Interviews were analyzed using grounded theory methodology, and surveys were analyzed with Wilcoxon tests. Randomization to clinical vignettes. Thematic differences in allocation of advanced therapies by patient race and gender. Among 46 participants (24 [52%] women, 20 [43%] racial minority), participants were randomized to the vignette of a white woman (20 participants [43%]), an African American woman (20 participants [43%]), a white man (3 participants [7%]), and an African American man (3 participants [7%]). Allocation differences centered on 5 themes. First, clinicians critiqued the appearance of the women more harshly than the men as part of their overall impressions. Second, the African American man was perceived as experiencing more severe illness than individuals from other racial and gender groups. Third, there was more concern regarding appropriateness of prior care of the African American woman compared with the white woman. Fourth, there were greater concerns about adequacy of social support for the women than for the men. Children were perceived as liabilities for women, particularly the African American woman. Family dynamics and finances were perceived to be greater concerns for the African American woman than for individuals in the other vignettes; spouses were deemed inadequate support for women. Last, participants recommended ventricular assist devices over transplantation for all racial and gender groups. Surveys revealed no statistically significant differences in allocation recommendations for African American and white women patients. This national study of health care professionals randomized to clinical vignettes that varied only by gender and race found evidence of gender and race bias in the decision-making process for offering advanced therapies for heart failure, particularly for African American women patients, who were judged more harshly by appearance and adequacy of social support. There was no associated between patient gender and race and final recommendations for allocation of advanced therapies. However, it is possible that bias may contribute to delayed allocation and ultimately inequity in the allocation of advanced therapies in a clinical setting.

The Covid-19 pandemic has already stressed health care systems throughout the world, requiring rationing of medical equipment and care. The authors discuss the ethical values relevant to health care rationing and provide six recommendations to guide fair allocation of scarce medical resources during the pandemic.

Physicians in northern Italy have learned some painful lessons about rationing care during an epidemic. As health care systems work out ethical allocation principles, it seems clear that only with transparency and inclusivity can public trust and cooperation be achieved.

The ongoing novel coronavirus disease (COVID-19) pandemic has already infected millions worldwide and, with no vaccine available, interventions to mitigate transmission are urgently needed. While there is broad agreement that travel restrictions and social distancing are beneficial in limiting spread, recommendations around face mask use are inconsistent. Here, we use mathematical modeling to examine the epidemiological impact of face masks, considering resource limitations and a range of supply and demand dynamics. Even with a limited protective effect, face masks can reduce total infections and deaths, and can delay the peak time of the epidemic. However, random distribution of masks is generally suboptimal; prioritized coverage of the elderly improves outcomes, while retaining resources for detected cases provides further mitigation under a range of scenarios. Face mask use, particularly for a pathogen with relatively common asymptomatic carriage, is an effective intervention strategy, while optimized distribution is important when resources are limited. Recommendations regarding the use of face masks as a preventive measure for COVID-19 are inconsistent. Here, the authors show that optimal distribution of surgical-standard face masks in the population, or universal coverage of homemade face coverings, could reduce total infections and deaths.

Background The COVID- 19 pandemic prompted rapid development of scarce resource allocation policies (SRAP) in case demand for critical health services eclipsed capacity. We sought to test whether a brief, educational video could improve alignment of participant values and preferences with the tenets of the University of California Health’s SRAP in a post hoc analysis of a randomized controlled trial (RCT) conducted during the pandemic. Methods An RCT of an educational video intervention embedded in a longitudinal web-based survey conducted from May to December 2020, analyzed in August 2024. The “explainer” video intervention was approximately 6 min long and provided an overview of the mechanics and ethical principles underpinning the UC Health SRAP, subtitled in six languages. California residents were randomized to view the intervention or not, stratified by age, sex, education, racial identity, and self-reported health care worker status. Non-California residents were assigned to the control group. 1,971 adult participants were enrolled at baseline, and 939 completed follow-up. 770 participants with matched baseline and follow-up responses were analyzed. Self-reported survey assessments of values regarding components of SRAP were scored as the percentage of agreement with the UC Health SRAP as written. Participants responded to items at baseline and follow-up (approximately 10 weeks after baseline), with randomization occurring between administrations. Results After the intervention, overall agreement improved by a substantial margin of 5.2% (from 3.8% to 6.6%, P  <.001) for the intervention group compared to the control group. Significant changes in agreement with SRAP logistics and health factors were also observed in the intervention group relative to the control, while no significant changes were noted for social factors. Differential intervention effects were observed for certain demographic subgroups. Conclusions A brief educational video effectively explains the complex ethical principles and mechanisms of the SRAP, as well as how to improve the alignment of participant values with the foundational principles of UC Health SRAP. This directly informs practice by providing a framework for educating individuals about the use of these policies during future situations that require crisis standards of care, which can, in turn, enhance agreement and buy-in from affected parties. Trial registration ClinicalTrials.gov registration NCT04373135 (registered 4 May 2020). Key points Question Can a brief educational video improve agreement with the ethical principles underlying scarce resource allocation policies (SRAP)? Findings In this post hoc analysis of a randomized controlled trial, we observed that overall agreement with SRAP improved by a significantly greater margin of 5.2% (3.8% to 6.6%, P <.001) for intervention relative to control. Effect heterogeneity was seen for some demographic subgroups. Meaning Educational interventions are effective for nudging alignment of personal values with ethical principles while observed effect heterogeneity highlights the need for additional research to tailor and target messaging to maximize buy-in.

As global populations age, a looming nursing shortage is anticipated to become a critical issue. Charge nurses have the responsibility of optimally allocating nursing resources to ensure the quality of patient care during a shift. Therefore, an accurate estimate of nursing demand is crucial. However, the ability to forecast future nursing demand remains underdeveloped, mainly because the nature of nursing demand is highly individualized and does not follow a definitive pattern. In practice, the nursing demand is often perceived as unpredictable, leading to an ad hoc approach to staffing. The primary objective of our study is to demonstrate that longitudinal data analysis can reveal strong statistical regularities in the temporal dynamics of nursing demand. This approach not only provides new possibilities for efficient resource allocation but also paves the way for data‐driven prediction of nursing demand. Our study uses Sankey diagrams to visualize the temporal dynamics of nursing demand within each ward for each fiscal year, representing these dynamics as an overlay of trajectories from multiple individual patients. Consequently, our study reveals ward‐specific statistical regularities in the temporal dynamics of nursing demand. In one ward, approximately 25% of patients experienced an increase in nursing demand from 1 to between 6 and 9 points from the second to the third day of hospitalization, while in another, only 0.1% showed such an increase. These findings suggest that patients admitted to the wards tend to exhibit a certain probabilistic change in nursing demand. This study can predict probabilistically the temporal variation of nursing demand among patients in the coming years by analyzing data on the temporal changes in nursing demand over the past years. Our findings are expected to significantly influence the forecasting of nursing demand and the estimation of nursing resources, leading to data‐driven and more efficient nursing management.

Irene Agyepong and colleagues share experiences and ideas to strengthen capacity for health research co-production in low and middle income countries

Background The inequitable allocation of health resources is a worldwide problem, and it is also one of the obstacles facing for health services utilization in China. A new round of health care reform which contains the important aspect of improving the equity in health resource allocation was released by Chinese government in 2009. The aim of this study is to understand the changes of equity in health resource allocation from 2009 to 2013, and make a further inquiry of the main factors which influence the equity conditions in China. Methods Data resources are the China Health Statistics Yearbook (2014) and the China Statistical Yearbook (2014). Four indicators were chosen to measure the trends in equity of health resource allocation. Data were disaggregated by three geographical regions: west, central, and east. Theil index was used to calculate the degree of unfairness. Results The total amount of health care resources in China had been increasing in recent years. However, the per 10, 000 km 2 number of health resources showed a huge gap in different regions, and per 10, 000 capita health resources ownership showed a relatively small disparities at the same time. The index of health resources showed an overall downward trend, in which health financial investment the most unfair from 2009 to 2012 and the number of health institutions the most unfair in 2013. The equity of health resources allocation in eastern regions was the worst except for the aspect of health technical personnel allocation. The regional contribution rates were lower than that of the inter-regional contribution rates which were all beyond 60 %. Conclusion The equity of health resource allocation improved gradually from 2009 to 2013. However, the internal differences within the eastern region still have a huge impact on the overall equity in health resource allocation. The tough issues of inequitable in health resource allocation should be resolved by comprehensive measures from a multidisciplinary perspective.