Long-term impact of environmental public health disaster on health system performance: experiences from the Graniteville, South Carolina chlorine spill.
Long-term impact of environmental public health disaster on health system performance: experiences from the Graniteville, South Carolina chlorine spill.
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环境公共卫生灾难对卫生系统绩效的长期影响：南卡罗来纳州格拉尼特维尔氯泄漏事件的经验。
DOI：
10.1097/smj.0b013e31827c54fc
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发表时间：
2013
影响因子：
1.1
通讯作者：
Svendsen,ErikR
中科院分区：
文献类型：
--
作者：
Runkle,JenniferR;Zhang,Hongmei;Karmaus,Wilfried;Brock-Martin,Amy;Svendsen,ErikR
目的在环境公共卫生灾难(EPHD)发生后，卫生保健系统可能是最不具备应对能力的。可预防的门诊敏感情况就诊(ACSC)可作为基于人群的指标，用于监测灾后卫生系统的就诊情况。这项研究的目的是检查脆弱亚人群中的ACSCs发病率是否对灾难的影响敏感。方法采用Poisson回归和广义估计方程，对两个对照组在灾后和灾前两个月的ACSC访客变化进行了回顾分析。结果直接组灾前ACSC就诊调整率是主对照组的1.68倍(95%CI：1.47，1.93)，灾后调整后ACSC住院率是主对照组的3.10倍(95%CI：1.97，5.18)。对于急诊科ACSC就诊，灾前直接受灾者调整后的ACSC就诊率是主对照组的1.82倍(95%CI：1.61，2.08)，而灾后调整后的ACSC率是主对照组的2.81倍(95%CI：1.92，5.17)。结论结果显示，对卫生系统需求的增加改变了对直接受灾难影响的弱势人群的卫生服务提供。对ACSC的可预防访问可以通过识别和描述灾难恢复期间的医疗差距来促进有意义的使用实践和公共卫生监测。
Objective In the aftermath of an Environmental Public Health Disaster (EPHD) a healthcare system may be the least equipped to respond. Preventable visits for ambulatory care sensitive conditions (ACSCs) may be used as a population-based indicator to monitor health system access post-disaster. The objective of this study was to examine whether ACSCs rates among vulnerable sub-populations are sensitive to the impact of a disaster. Methods We conducted a retrospective analysis using Poisson regression with generalized estimating equations to calculate change in monthly ACSC visits at the disaster site in the post-disaster period compared to the pre-disaster period after adjusting for parallel changes in two control groups. Results The adjusted rate of an ACSC hospital visit pre-disaster for the direct group was 1.68 times the rate for the primary control group (95% CI: 1.47, 1.93), while the adjusted ACSC hospital rate post-disaster for the direct group was 3.10 times the rate for the primary control group (95% CI: 1.97, 5.18). For emergency department ACSC visits, the adjusted rate among those directly affected pre-disaster were 1.82 times the rate for the primary control group (95% CI: 1.61, 2.08), while the adjusted ACSC rate post-disaster was 2.81 times the rate for the primary control group (95% CI: 1.92, 5.17). Conclusions Results revealed increased demand on the health system altered health services delivery for vulnerable populations directly impacted by the disaster. Preventable visits for ACSCs may advance meaningful use practice and public health surveillance by identifying and characterizing healthcare disparities during disaster recovery.