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Leveraging a Preexisting Global Infectious Disease Network for Local Decision Making During a Pandemic.

ABSTRACT: Emerging infectious disease epidemics require a rapid response from health systems; however, evidence-based consensus guidelines are generally absent early in the course of events. Formed in 2017 by 5 high-level isolation units spanning 3 continents, the experience of the Global Infectious Disease Preparedness Network (GIDPN) early in the course of coronavirus disease 2019 (COVID-19) provides a model for accelerating best practice development and improving decision-making in health emergencies. The network served as a platform for real-time, open and transparent information-sharing during unknowns of an active outbreak by clinicians caring for patients, by researchers conducting clinical trials and transmission and infection prevention studies, and by teams advising local and national policy makers. Shared knowledge led to earlier adoption of some treatment modalities as compared to most peer institutions and to implementation of protocols prior to incorporation into national guidelines. GIDPN and similar networks are integral in enhancing preparedness for and response to future epidemics/pandemics.

SUBMITTER: Herstein JJ

PROVIDER: S-EPMC8406886 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

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Leveraging a Preexisting Global Infectious Disease Network for Local Decision Making During a Pandemic.

Herstein Jocelyn J JJ Lowe John J JJ Wolf Timo T Vasoo Shawn S Leo Yee Sin YS Chin Bum Sik BS Shen Yinzhong Y Hewlett Angela L AL Lawler James V JV

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20220301 4

Emerging infectious disease epidemics require a rapid response from health systems; however, evidence-based consensus guidelines are generally absent early in the course of events. Formed in 2017 by 5 high-level isolation units spanning 3 continents, the experience of the Global Infectious Disease Preparedness Network (GIDPN) early in the course of coronavirus disease 2019 (COVID-19) provides a model for accelerating best practice development and improving decision-making in health emergencies. ...[more]

PMID: 34318871

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Project description:BackgroundMeta-analysis is often used to make generalisations across all available evidence at the global scale. But how can these global generalisations be used for evidence-based decision making at the local scale, if the global evidence is not perceived to be relevant to local decisions? We show how an interactive method of meta-analysis-dynamic meta-analysis-can be used to assess the local relevance of global evidence.ResultsWe developed Metadataset ( www.metadataset.com ) as a proof-of-concept for dynamic meta-analysis. Using Metadataset, we show how evidence can be filtered and weighted, and results can be recalculated, using dynamic methods of subgroup analysis, meta-regression, and recalibration. With an example from agroecology, we show how dynamic meta-analysis could lead to different conclusions for different subsets of the global evidence. Dynamic meta-analysis could also lead to a rebalancing of power and responsibility in evidence synthesis, since evidence users would be able to make decisions that are typically made by systematic reviewers-decisions about which studies to include (e.g. critical appraisal) and how to handle missing or poorly reported data (e.g. sensitivity analysis).ConclusionsIn this study, we show how dynamic meta-analysis can meet an important challenge in evidence-based decision making-the challenge of using global evidence for local decisions. We suggest that dynamic meta-analysis can be used for subject-wide evidence synthesis in several scientific disciplines, including agroecology and conservation biology. Future studies should develop standardised classification systems for the metadata that are used to filter and weight the evidence. Future studies should also develop standardised software packages, so that researchers can efficiently publish dynamic versions of their meta-analyses and keep them up-to-date as living systematic reviews. Metadataset is a proof-of-concept for this type of software, and it is open source. Future studies should improve the user experience, scale the software architecture, agree on standards for data and metadata storage and processing, and develop protocols for responsible evidence use.

Project description:BackgroundInter-hospital patient transfers to hospitals with greater resource availability and expertise may improve clinical outcomes. However, there is little guidance regarding how patient transfer requests should be prioritized when hospital resources become scarce.ObjectiveTo understand the experiences of healthcare workers involved in the process of accepting inter-hospital patient transfers during a pandemic surge and determine factors impacting inter-hospital patient transfer decision-making.DesignWe conducted a qualitative study consisting of semi-structured interviews between October 2021 and February 2022.ParticipantsEligible participants were physicians, nurses, and non-clinician administrators involved in the process of accepting inter-hospital patient transfers. Participants were recruited using maximum variation sampling.ApproachSemi-structured interviews were conducted with healthcare workers across Michigan.Key resultsTwenty-one participants from 15 hospitals were interviewed (45.5% of eligible hospitals). About half (52.4%) of participants were physicians, 38.1% were nurses, and 9.5% were non-clinician administrators. Three domains of themes impacting patient transfer decision-making emerged: decision-maker, patient, and environmental factors. Decision-makers described a lack of guidance for transfer decision-making. Patient factors included severity of illness, predicted chance of survival, need for specialized care, and patient preferences for medical care. Decision-making occurred within the context of environmental factors including scarce resources at accepting and requesting hospitals, organizational changes to transfer processes, and alternatives to patient transfer including use of virtual care. Participants described substantial moral distress related to transfer triaging.ConclusionsA lack of guidance in transfer processes may result in considerable variation in the patients who are accepted for inter-hospital transfer and in substantial moral distress among decision-makers involved in the transfer process. Our findings identify potential organizational changes to improve the inter-hospital transfer process and alleviate the moral distress experienced by decision-makers.

Dataset Information

Leveraging a Preexisting Global Infectious Disease Network for Local Decision Making During a Pandemic.

Publications

Leveraging a Preexisting Global Infectious Disease Network for Local Decision Making During a Pandemic.

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