The Puerto Rico Healthcare System Before and After Three Public Health Disasters

项目摘要/摘要 包括飓风、洪水和地震在内的强烈自然灾害更加频繁， 近几年来，它们之间的距离很近。大规模自然灾害可能会严重破坏和降低医疗保健水平 设施结构完整性和设备，造成环境危害，并对卫生服务产生负面影响 交付(例如，取消手术；推迟预防性护理；药房关闭；人员配备、药物和 医疗供应短缺；急诊科数量大幅瞬间激增)--所有这些都有助于 卫生保健提供者的压力增加。将传染病疫情叠加到自然环境中 灾难进一步加剧了医疗保健系统的压力。在三年的时间里，波多黎各遭受了 接连发生3起重大突发公共卫生事件，包括2起自然灾害和1起大流行。第一, 飓风玛丽亚于2017年9月袭击，在全岛造成重大破坏。迷失的社区 获得基本服务，如电力、饮用水、安全道路和桥梁以及医疗保健。多数 岛上的公共和私人卫生保健设施关闭或容量有限达数月之久。第二，在 2019年12月，波多黎各连续发生500多次2.0级以上地震，造成 更多的基础设施对许多苦苦挣扎的卫生设施造成破坏，导致数千人无家可归或生活 在外面他们的院子里。第三，波多黎各继续应对新型冠状病毒-19(新冠肺炎) 大流行。这项研究将提供一个独特的机会来了解三种不同的公共卫生的影响 紧急情况对健康和医疗保健差距很大的少数群体的影响。我们设计了一种 混合方法，多层次研究，将定量和定性数据三角化，以研究前后 3起突发公共卫生事件对波多黎各卫生保健系统的准备、反应和 恢复工作以及紧急情况如何影响恢复能力、体验和利用 岛上的医疗保健系统。这项研究将使用50家综合医院和20家医院的行政使用数据 联邦政府资助的岛上卫生中心，对卫生系统领导人和提供者的定性访谈，以及 对3062名岛上成年居民的代表性队列进行后续访谈。使用唐纳贝德式的品质 作为我们研究框架的卫生系统复原力的新兴文献中的护理模式和概念，我们 将1)找出影响波多黎各卫生保健系统准备、应对 飓风玛丽亚、地震和新冠肺炎的影响和恢复，2)对 多场灾难对卫生系统复原力的影响以及这些影响如何相互作用，以及3)从中吸取教训 医疗保健领导者和提供者。我们将综合我们三角研究方法中的信息 为有效和协调的缓解办法提供数据驱动的建议， 在灾害频率和强度不断增加的情况下的准备、反应和复原力。

PROJECT SUMMARY/ABSTRACT Intense natural disasters including hurricanes, floods, and earthquakes have become more frequent and closely spaced in recent years. Large scale natural disasters can severely damage and degrade health care facility structural integrity and equipment, create environmental hazards, and negatively affect health service delivery (e.g., cancelled surgeries; postponed preventive care; pharmacy closures; staffing, medication, and medical supply shortages; large transient surges in emergency department volume) – all of which contribute to increased stress among health care providers. Superimposing infectious disease epidemics on the natural disasters further exacerbates stress on the health care system. Over the span of 3 years, Puerto Rico suffered from 3 major back-to-back public health emergencies including 2 natural disasters and a pandemic. First, Hurricane Maria hit in September 2017 causing major devastation throughout the island. Communities lost access to essential services such as electricity, potable water, safe roads and bridges, and health care. Most of the island’s public and private health care facilities closed or had limited capacity for months. Second, in December 2019, a series of more than 500 quakes of magnitude 2.0 or greater struck Puerto Rico causing more infrastructure damage to many struggling health facilities and leaving thousands homeless or living outside in their yards. Third, Puerto Rico continues to deal with the novel coronavirus-19 (COVID-19) pandemic. This study will provide a unique opportunity to understand the effects of 3 distinct public health emergencies on a minority population with significant health and health care disparities. We have designed a mixed methods, multi-level study that will triangulate quantitative and qualitative data to study the pre and post effects of the 3 public health emergencies on Puerto Rico’s health care system’s preparedness, response, and recovery efforts and how the emergencies have affected the resiliency, experiences, and utilization of the island’s health care system. The study will use administrative utilization data from 50 general hospitals and 20 federally funded health centers on the island, qualitative interviews of health system leaders and providers, and follow-up interviews of a representative cohort of 3,062 island adult residents. Using the Donabedian quality of care model and concepts from an emerging literature on health system resilience as our study framework, we will 1) identify factors that influenced the capacity of Puerto Rico’s health care system to prepare for, respond to, and recover from Hurricane Maria, the earthquakes, and COVID-19, 2) model the cumulative effects of multiple disasters on health system resiliency and how these effects interact, and 3) elicit lessons learned from health care leaders and providers. We will synthesize the information from our triangulated research approach to provide data driven recommendations for an effective and coordinated approach to mitigation, preparedness, response, and resiliency under conditions of increasing frequency and intensity of disasters.