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Impacts of the 2017 Hurricanes on Emergency Department Admissions and Outcomes in St. Thomas, USVI

2017 年飓风对美属维尔京群岛圣托马斯市急诊科入院和结果的影响

基本信息

批准号：
9976593
负责人：
John Glenn Morris
金额：
$ 18.98万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-11 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9976593
关键词：
Accident and Emergency department Acute Adherence Admission activity Age Aging Air Air Ambulances Back Beds Behavioral Cancer Center Cardiac Catheterization Procedures Caribbean region Caring Categories Cessation of life Chronic Chronic Disease Communities Data Demographic Factors Diagnosis Diagnostic Disasters Disease Documentation Elderly Emergency Department patient Ethnic Origin Future Gender Health Health Personnel Health Services Hospitalization Hospitals Hurricane Intervention Island Laboratories Locales Magnetic Resonance Imaging Medical Medical center Mental Depression Minority Modeling Morbidity - disease rate Outcome Patient Self-Report Patients Perception Persons Phase Physicians Population Primary Health Care Public Health Race Recovery Risk Services Social Network Social support Time United States United States Virgin Islands Visit Work comorbidity coping functional status health care service health care service utilization hospital readmission individual patient mortality older patient patient population resilience respiratory response

项目摘要

Project Summary/Abstract The USVI was hit by two successive, Category 5 hurricanes in September 2017: Hurricanes Irma and Maria. The storms caused massive damage on the islands, including partial destruction of the Schneider Regional Medical Center (SRMC), the only hospital on St. Thomas, with a reduction in available beds from 169 to <40, destruction of its Cancer Center and heart catheterization laboratories and reduced respiratory support, CT, and MRI capabilities. Provision of medical services has been further hampered by pre- and post-hurricane related departures of physicians and other medical personnel. Persons with the most serious conditions continue to be sent by air ambulance to hospitals in the continental United States, with others discharged back to the community to collapsed primary care, public health, and social networks. There was a perception on the part of physicians remaining on the island that mortality rates were up, particularly among poor, elderly patients with chronic conditions: in the words of one physician, “they're just giving up and dying.” The current proposal seeks to provide documentation and increase understanding of the short and long term health risks and impacts of the 2017 hurricanes, focusing on the SRMC Emergency Department as the primary access point for medical care on St. Thomas post-hurricane. Studies will assess acute hurricane-related medical conditions and the exacerbation of chronic diseases in the setting of a) severely disrupted health care services; b) individual patient factors; and c) a collapse of culturally-relevant social support networks, particularly for aging patients. Data will provide a basis for acute interventions as well as long-term disaster management planning to promote resilience, and will feed into subsequent modeling efforts focused on aspects unique to the Afro-Caribbean population of St. Thomas, USVI. Specific Aims include: Aim1: Characterize the differences in medical (diagnosis, co-morbidities, presence/absence of chronic disease, mortality) and demographic factors (age, gender, race/ethnicity, SES, payer status) for periods pre- and post-hurricanes, and by disposition (air ambulance transfer; hospital admission, discharge back to community). Aim 2: Follow 300 post-disaster ED patients ages 55+ with chronic medical diseases who were discharged back to the community at two time epochs (12 and 24 months) to characterize their demographic (age, gender, race/ethnicity); health care utilization (primary care visits); medical (co-morbidities); behavioral (medical adherence, coping style, depression, self-reported resilience) and social network status and identify the association of these factors with outcome (death, readmission to ED or hospital; functional status).

项目总结/文摘