Randomized Controlled Trial

. 2025 Apr 14;25(1):540.

doi: 10.1186/s12913-025-12712-x.

Bolstering agreement with scarce resource allocation policy using education: a post hoc analysis of a randomized controlled trial

Russell G Buhr^{1

2

3}, Cher X Huang^{4

5}, Ruby Romero⁶, Lauren E Wisk^{6

5}

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, USA. rbuhr@mednet.ucla.edu.
² Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA. rbuhr@mednet.ucla.edu.
³ Department of Health Policy and Management, Fielding School of Public Health at the University of California, Los Angeles, Los Angeles, CA, USA. rbuhr@mednet.ucla.edu.
⁴ Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, USA.
⁵ Department of Health Policy and Management, Fielding School of Public Health at the University of California, Los Angeles, Los Angeles, CA, USA.
⁶ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.

PMID: 40229711
PMCID: PMC11995607
DOI: 10.1186/s12913-025-12712-x

Randomized Controlled Trial

Bolstering agreement with scarce resource allocation policy using education: a post hoc analysis of a randomized controlled trial

Russell G Buhr et al. BMC Health Serv Res. 2025.

. 2025 Apr 14;25(1):540.

doi: 10.1186/s12913-025-12712-x.

Authors

Russell G Buhr^{1

2

3}, Cher X Huang^{4

5}, Ruby Romero⁶, Lauren E Wisk^{6

5}

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, USA. rbuhr@mednet.ucla.edu.
² Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA. rbuhr@mednet.ucla.edu.
³ Department of Health Policy and Management, Fielding School of Public Health at the University of California, Los Angeles, Los Angeles, CA, USA. rbuhr@mednet.ucla.edu.
⁴ Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, USA.
⁵ Department of Health Policy and Management, Fielding School of Public Health at the University of California, Los Angeles, Los Angeles, CA, USA.
⁶ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.

PMID: 40229711
PMCID: PMC11995607
DOI: 10.1186/s12913-025-12712-x

Abstract

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).

Keywords: Crisis standards of care; Critical care; Internet-based survey; Patient education; Scarce resource allocation.

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Conflict of interest statement

Declarations. Ethics approvals and consent to participate: The UCLA Institutional Review Board (20–000683) reviewed and approved this study in accordance with the provisions in the Declaration of Helsinki. All participants provided electronic informed consent. Consent for publication: Not applicable. Competing interests: Dr. Buhr reports personal consulting fees for DynaMed/American College of Physicians and Optum and serving on an advisory board for Chiesi, unrelated to this work and is an employee of the Veterans Health Administration. The views and positions in this manuscript do not necessarily reflect those of the Department of Veterans Affairs. Drs. Huang, Wisk, and Ms. Romero have nothing to report.

Figures

**Fig. 1**
CONSORT diagram demonstrating participant flow and randomization. Alt text: a flow diagram demonstrating how participants were allocated into groups for the study

**Fig. 2**
Marginal estimated change in agreement of respondents with UC SRAP tenets by randomization group, overall, and by domain. *P < 0.05, **P < 0.01, ***P < 0.001, N.S = not significant. Alt text: a series of line charts showing estimates of change in agreement with scarce resource policy by randomization group and timepoint

See this image and copyright information in PMC

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Bolstering agreement with scarce resource allocation policy using education: a post hoc analysis of a randomized controlled trial

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Bolstering agreement with scarce resource allocation policy using education: a post hoc analysis of a randomized controlled trial

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