Strategies for Combatting Health Disparities in Prioritization Schema for Medically-Necessary Time-Sensitive Orthopaedic Surgeries

• Published in: Journal of health care for the poor and underserved Vol. 34; no. 4; pp. 1479 - 1491
• Main Authors: Colomb, Eric, Lapedis, Cathryn J, Hallstrom, Brian R, Crawford, Eileen A, Smith, Lauren B
• Format: Journal Article
• Language: English
• Published: United States Johns Hopkins University Press 01.11.2023
• Subjects: Chronic obstructive pulmonary disease; Comorbidity; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; Criticism; Diabetes; Employment; Guidelines; Health care policy; Health disparities; Health insurance; Health Priorities; Healthcare Disparities; Hospitals; Humans; Hypertension; Infections; Infrastructure; Intensive care; Length of stay; Low income groups; Medicaid; Medicare; Minority & ethnic groups; Nosocomial infection; Nosocomial infections; Occupations; Orthopedic Procedures; Orthopedic surgery; Orthopedics; Pandemics; Patients; Personal protective equipment; Populations; Practice Guidelines as Topic; Prioritizing; Protective equipment; Questionnaires; Rehabilitation; Social factors; Surgery; Tracking; Vulnerability; Welfare; United States > US; Detroit Michigan
• ISSN: 1049-2089; 1548-6869; 1548-6869
• DOI: 10.1353/hpu.2023.a912731

A decrease in non-emergent procedure volume was observed during the COVID-19 pandemic to conserve protective equipment, increase hospital capacity, and limit nosocomial infection. Decreasing COVID-19 infection rates, paired with increasing hospital financial pressure and concerns for patient welfare, have prompted the development of guidelines for re-introduction of medically-necessary time-sensitive (MeNTS) procedures. Such protocols have received criticism for potentially perpetuating inequities disfavoring vulnerable populations. Limited access to testing supplies and protective equipment, coupled with higher incidence of medical comorbidities attributable to social determinants of health, disadvantages vulnerable populations in seemingly objective prioritization schema. Here, we detail both an analysis of current guidelines as well as strategies aimed at mitigating these disparities (including prioritizing essential infrastructure workers, implementing questionnaires, improving scheduling communication, tracking patients via ZIP codes and insurance status, facilitating post-operative rehabilitation, acknowledging physician bias, and favoring lottery selection over first-come, first-served). These guidelines and strategies can apply to future pandemics and even routine prioritization schema.