Vision Grant Research Seeks to Address Rationing in the ICU

2009 - 3 August - Obesity in the ICU
The Society of Critical Care Medicine (SCCM) awarded its 2009 Vision Grant to Scott D. Halpern, MD, PhD, for improving clinical outcomes in the intensive care unit.
The Society of Critical Care Medicine (SCCM) awarded its 2009 Vision Grant to a young investigator dedicated to improving clinical outcomes in the intensive care unit (ICU). Society member Scott D. Halpern, MD, PhD, was awarded the $50,000 grant to aid research that he hopes will shed light on ethical issues related to rationing care in the ICU, a topic of pressing importance as demand for critical care services is expected to outpace the supply of resources in the coming decades. Drawing upon his background as an ethicist and epidemiologist, Halpern is using empirical methods to address issues that harbor ethical implications. “The issue of ICU rationing is a loaded one; it’s an issue that has been mired in a largely theoretical and ethical debate that I think misses the point,” he explained. “Rationing is inevitable and that in and of itself is not an ethical problem. The ethical questions are whether we are rationing efficiently and fairly.”

Halpern is working to collect the data and analyses that will serve as the building blocks for his long-term goals of identifying patterns of rationing in the ICU, and the SCCM Vision Grant has been particularly helpful in facilitating these initial processes.

“The Vision Grant has been a wonderful opportunity. It’s enabled me to initiate this research at an earlier stage in my career than I might have been able to otherwise. It’s also provided the resources I need, from a programming and statistical standpoint, to generate preliminary data that will enable me to be competitive for bigger and longer-term grants from other sources in the very near future.”

An early analysis of 120 ICUs throughout the United States is already revealing relevant and important data, painting a picture of how healthcare may operate once demand – driven by the aging population and increased life expectancy – surpasses supply. Halperrn and his team have collected ICU census data (those patients cared for in a unit for at least two hours) from 2002 to 2008, revealing that this measure varies significantly from day to day. “There already are days where we have extremely high demand for critical care – demand that is three, five and seven times what we see on the slowest days. What happens on those high-demand days may give us good insight into how all our days might be in the future,” Halpern explained.

“If you think of the ICU like a balloon, as more and more air fills the balloon, it stretches more thinly,” he said. “But eventually, the balloon is going to burst, and there are going to be some consequences. In the ICU, compromises are going to have to be made, and that’s okay. The concern is not that rationing is going to take place, it is how it is going to take place. The questions from a critical care perspective are: Are we providing care as equitably and as efficiently as we could be? Are we rationing away from certain groups in ways that are not justified?”

These questions are important to the critical care community. Halpern’s nominating colleagues noted that his scholarship has great potential to bring the breadth and consequences of rationing decisions to light and to define the most promising targets for corrective intervention. Halpern already has established himself as a future leader in critical care, having an extraordinary publication record, a substantial national reputation, and a strong track record in obtaining previous grant support. He is presently an assistant professor of medicine and epidemiology (in pulmonary and critical care) and senior fellow at the Leonard Davis Institute of Health Economics and Center for Bioethics. Both positions are within the University of Pennsylvania.

It is time again to apply for the 2010 Vision Grant. Investigator-initiated research should help expand and advance understanding of clinical outcomes specifically related to these goals. To qualify, the principal investigator must be a current SCCM member and maintain SCCM membership through the life of the grant. Applications are encouraged from junior and established investigators.