SAFEHAVEN: Decision Support for Nursing Home Resident Disaster Evacuations

描述(由申请人提供)：通过健康评估促进养老院中脆弱老年人疏散的战略方法(避风港研究)。自2001年9月11日事件以来，数十亿美元的联邦资金被用于改善该国的防备状态和公共卫生基础设施。大部分注意力集中在传统的急救人员(即消防、警察、EMS)和医院准备工作上，而较少关注非急性医疗机构的准备工作，如疗养院(NH)。为弱势群体制定应急计划是社区备灾的主要内容，老年人是最脆弱的群体。NH居民特别脆弱，因为他们有广泛的护理需求，因此与灾害相关的风险更高。然而，传统上，国民保健制度没有被纳入任何级别的灾害规划，这一缺陷必须加以弥补，以避免与卡特里娜飓风和丽塔飓风有关的悲惨事件再次发生，并防止在飓风必然来袭时发生类似的悲剧。我们的建议是对美国国立卫生研究院项目公告06-454“灾害与健康行为研究”的直接回应。该公告呼吁开展可直接用于发展公共卫生结构和干预措施的应用研究，以纠正目前缺乏对为弱势老年人服务的保健机构的关注。利用2004年至2007年期间袭击佛罗里达州和墨西哥湾沿岸各州的联邦医疗保险索赔、季度NH居民评估数据、纵向设施文件和地理编码数据，我们建议估计飓风对NH居民发病率和死亡率的影响。此外，我们将使用疗养院与飓风预测路径之间的距离作为工具，评估疏散或避难决定对居民结果的影响。将为主要的医学和公共卫生杂志以及更多面向应用和从业者的渠道，包括网站，传播研究结果。我们还将召集一个与年度飓风峰会相关的利益相关者咨询小组，以帮助我们传播结果，以最大限度地提高州养老院监管机构和应急协调官员对研究结果的警觉。公共卫生相关性：飓风对养老院居民造成毁灭性影响，因为他们可能会因为被转移到另一个环境或原地避难而受到不利影响。这项研究使用来自多个来源的现有疗养院数据，试图了解飓风和疏散决定的后果，为制定疏散指南提供第一个证据基础。

DESCRIPTION (provided by applicant): Strategic Approach to Facilitating Evacuation by Health Assessment of Vulnerable Elderly in Nursing Homes (SAFE HAVEN Study). Since the events of September 11th 2001, billions of federal dollars have been devoted to improving the country's preparedness posture and public health infrastructure. Most of the attention has focused on traditional first responders (i.e. fire, police, EMS) and hospital preparedness and less to preparedness among non-acute healthcare facilities such as nursing homes (NH). Emergency planning for vulnerable populations constitutes a major element of community disaster preparedness and the elderly represent a most vulnerable group. NH residents are especially vulnerable, as they have extensive care needs and therefore, higher disaster-associated risks. However, NHs have not traditionally been incorporated into disaster planning at any level, a deficiency that must be remedied to avert a recurrence of the tragic events that occurred in connection with Hurricanes Katrina and Rita and to prevent similar tragedies when hurricanes are bound to strike. Our proposal is a direct response to NIH Program Announcement 06-454 "Behavioral Research on Disasters and Health". The announcement calls for applied research that can be directly utilized in the development of public health structures and interventions designed to redress the current lack of attention focused on health care institutions that serve the vulnerable elderly. Using Medicare claims, quarterly NH resident assessment data, longitudinal facility files and geo-coded data on each hurricane hitting Florida and the Gulf coast states between 2004 and 2007, we propose to estimate the impact of hurricanes on NH residents' morbidity and mortality. Furthermore, using the distance between the nursing home and the predicted path of the hurricane as an instrument, we will estimate the effect of the decision to evacuate or shelter in place on residents' outcomes. Dissemination of study findings will be designed for major medical and public health journals as well as more applied and practitioner oriented outlets including web sites. We will also convene an advisory group of stakeholders associated with the annual Hurricane Summit to assist us with dissemination of results to maximize the likelihood that both state nursing home regulators as well as emergency response coordination officials are alerted to the results of the study. PUBLIC HEALTH RELEVANCE: Hurricanes have a devastating effect on nursing home residents since they may be adversely affected either by being transferred to another setting or by sheltering in place. Using existing nursing home data from multiple sources, this study seeks to understand the consequences of hurricanes and evacuation decisions, providing the first evidence base to inform the creation of evacuation guidelines.