Deriving an Evidence Base for Emergency Management in U.S. Hospitals: Toward Resilience in the Midst of COVID-19

获取美国医院应急管理的证据基础：在 COVID-19 中实现恢复力

• 批准号: 10193529
• 负责人: Mariam Krikorian Atkinson
• 金额: $ 41.63万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10193529
• 关键词: Deriving; Evidence; Base; Emergency; Management

As U.S. hospitals moved quickly to make plans and respond to the COVID-19 pandemic, many struggled with significant challenges in managing the crisis simultaneously with maintaining the health and safety of patients and hospital staff. This event has demonstrated the need for hospitals to develop effective emergency management (EM) programs to deal with the current crisis and future disaster events. Federal agencies and others have published guidelines on hospital EM, but these guidelines frequently change, are sometimes inconsistent, and do not describe the process for effectively managing emergencies and expected outcomes. Consequently, hospitals have invoked a variety of EM practices in dealing with COVID-19, with varying impact. The variation in EM is especially salient when comparing rural and urban hospitals, which not only differ in terms of resources and the surge in COVID-19 cases, but rural hospitals are typically located in areas with a larger high-risk population of patients with underlying conditions who can have greater complications if COVID- 19 is contracted. Therefore, it is critical to understand hospital EM in response to COVID-19 across both urban and rural settings. Building on prior research, we hypothesize that successful EM programs have distinguishing attributes. First, effective EM practices demonstrate elements of resilience, or capabilities to respond to disruptive events with minimal negative impact to performance. Second, effective EM includes a mixture of formal mechanisms such as standardized protocols and reporting structures, as well as informal mechanisms, such as adaptive routines and flexible roles. Our research examines the EM practices of 12 urban and rural hospitals to identify effective techniques and processes that enabled these organizations to provide quality care and move toward resilience during and after COVID-19. We will use qualitative and quantitative approaches to examine how the combination of EM practices employed by hospitals contributed to resilience, improved health outcomes, and stronger hospital performance overall. We first plan to conduct interviews with hospital executives and clinical leaders directly involved in EM during COVID-19 so we can identify and compare EM practices across each of the study hospitals using thematic analysis (Aim 1). Next, we will use the interview data in Aim 1 to design surveys which we will administer to key personnel at each hospital. Using factor analysis, we will develop a validated scale to assess the saliency of different EM practices, formal and informal mechanisms, and resilience (Aim 2). Last, we will conduct complementary quantitative analyses to examine patient outcomes and hospital performance in relation to the EM scales we developed in Aim 2, so that we can determine which practices and mechanisms of implementing EM were most effective. From these findings we will identify core elements and benchmarks of successful EM programs for broad dissemination (Aim 3). Through our research, we aim to provide hospitals with evidence-based EM practices that will better equip them for the current crisis and future disasters.

随着美国医院迅速采取行动制定计划和应对新冠肺炎大流行，许多医院正在努力应对 在管理危机的同时维护患者的健康和安全方面的重大挑战 和医院工作人员。这一事件表明了医院制定有效应急措施的必要性 管理(EM)计划，以应对当前的危机和未来的灾难事件。联邦机构和 其他人发布了关于医院EM的指导方针，但这些指导方针经常变化，有时 不一致，并且没有描述有效管理紧急情况和预期结果的过程。 因此，医院在处理新冠肺炎问题时引用了各种EM做法，产生了不同的影响。 在比较农村和城市医院时，EM的差异尤其明显，这两家医院不仅在 在资源和新冠肺炎病例激增方面，但乡村医院通常位于 基础疾病患者中更大的高危人群，如果COVID- 19是签约的。因此，了解医院EM以应对城市和城市的新冠肺炎是至关重要的 和乡村环境。在先前研究的基础上，我们假设成功的EM项目具有与众不同的 属性。首先，有效的环境管理实践展示了应变能力或应对能力 对性能的负面影响最小的破坏性事件。其次，有效的新兴市场包括以下几个方面 正式机制，如标准化协议和报告结构，以及非正式机制， 例如适应性的套路和灵活的角色。 我们的研究考察了12家城乡医院的EM实践，以确定有效的技术和 使这些组织能够在期间和之后提供高质量护理并走向复原力的流程 新冠肺炎。我们将使用定性和定量的方法来研究EM的组合 医院采用的做法有助于提高复原力、改善健康结果和加强医院建设 整体表现。我们首先计划直接采访医院高管和临床负责人 在新冠肺炎期间参与EM，以便我们可以确定和比较每个研究中的EM实践 使用专题分析的医院(目标1)。接下来，我们将使用目标1中的访谈数据来设计调查， 我们将对每家医院的关键人员进行管理。使用因子分析，我们将开发一个经过验证的量表，以 评估不同的环境管理做法、正式和非正式机制以及复原力的重要性(目标2)。最后的, 我们将进行互补的量化分析，以检查患者的结果和医院的表现 关于我们在目标2中开发的EM量表，以便我们可以确定哪些做法和机制 实施环境管理是最有效的。从这些调查结果中，我们将确定核心要素和基准 广泛传播的成功的环境管理方案(目标3)。通过我们的研究，我们的目标是为医院 以证据为基础的新兴市场实践，将更好地为当前的危机和未来的灾难做好准备。