Multi-Criteria Decision Analysis to prioritize hospital admission of patients affected by COVID-19 in low-resource settings with hospital-bed shortage
Pasquale De Nardo, Elisa Gentilotti, Fulvia Mazzaferri, Eleonora Cremonini, Paul Hansen, Herman Goossens, Evelina Tacconelli, Emanuele Durante‐Mangoni, L.L. Florio, Rosa Zampino, Ferruccio Mele, Ivan Gentile, Biagio Pinchera, Nicola Coppola, Mariantonietta Pisaturo, Roberto Luzzati, Nicola Petrosillo, Emanuele Nicastri, Angela Corpolongo, Maria Adriana Cataldo, Alessandra D’Abramo, Gaetano Maffongelli, Laura Scorzolini, Claudia Palazzolo, Evangelo Boumis, Angelo Pan, Antonella d’Arminio Monforte, Fan Bai, Spinello Antinori, Francesco Giuseppe De Rosa, Silvia Corcione, Tommaso Lupia, Simone Mornese Pinna, Stefano Scabini, Francesca Canta, S Belloro, Zeno Bisoffi, Andrea Angheben, Federico Gobbi, E Turcato, Niccolò Ronzoni, Luca Moro, Silvia Calabria, P. Rodari, G Bertoli, G. Marasca, Massimo Puoti, Andrea Gori, Alessandra Bandera, Davide Mangioni, Maurizio Rizzi, Francesco Castelli, Arturo Montineri, C. Coco, Maddalena Maresca, Mattia Frasca, Donatella Aquilini, Matteo Vincenzi, Lorenza Lambertenghi, M.E. De Rui, Elisabetta Razzaboni, Paolo Cattaneo, Angelita Visentin, Anna Erbogasto, Ilaria Dalla Vecchia, I Coledan, Marta Vecchi, Giorgia Be, L. Motta, Amina Zaffagnini, Nancy A. Auerbach, P. Del Bravo, Anna Maria Azzini, Elda Righi, Elena Carrara, Alessia Savoldi, Marcella Sibani, E Lattuada, Giada Carolo, Maria Isabel Cunha Vieira Cordioli, Fabio Soldani, Maria Diletta Pezzani, S. Avallone, Raffaele Bruno, Alessandra Ricciardi, Maria Saggese, Giovanni Malerba
Abstract
OBJECTIVE: To use Multi-Criteria Decision Analysis (MCDA) to determine weights for eleven criteria in order to prioritize COVID-19 non-critical patients for admission to hospital in healthcare settings with limited resources. METHODS: The MCDA was applied in two main steps: specification of criteria for prioritizing COVID-19 patients (and levels within each criterion); and determination of weights for the criteria based on experts' knowledge and experience in managing COVID-19 patients, via an online survey. Criteria were selected based on available COVID-19 evidence with a focus on low- and middle-income countries (LMICs). RESULTS: saturation (15.9%); chest X-ray (14.1%); Modified Early Warning Score-MEWS (11.4%); respiratory rate (9.5%); comorbidities (6.5%); living with vulnerable people (6.4%); body mass index (5.6%); duration of symptoms before hospital evaluation (5.4%); CRP (5.1%); and age (3.8%). CONCLUSIONS: At the beginning of a new pandemic, when evidence for disease predictors is limited or unavailable and effective national contingency plans are difficult to establish, the MCDA prioritization model could play a pivotal role in improving the response of health systems.