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

项目概要/摘要 包括飓风、洪水和地震在内的强烈自然灾害变得更加频繁， 近几年来，大规模的自然灾害会严重破坏和降低卫生保健水平 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 递送（例如，取消手术;推迟预防性护理;药房关闭;人员配备，药物， 医疗供应短缺;急诊室数量的大幅瞬时激增）-所有这些都有助于 增加了医疗保健提供者的压力。将传染病流行叠加在自然环境中， 灾害进一步加剧了卫生保健系统的压力。三年来，波多黎各遭受了 包括两次自然灾害和一次大流行病在内的三次重大突发公共卫生事件。第一、 2017年9月，飓风玛丽亚袭击该岛，造成严重破坏。失去的社区 获得基本服务，如电力、饮用水、安全的道路和桥梁以及保健。最 岛上的公共和私人保健设施关闭或能力有限达数月之久。二是 2019年12月，波多黎各发生了一系列500多次2.0级或以上的地震， 许多苦苦挣扎的医疗设施遭到更多的基础设施破坏，数千人无家可归或 在他们的院子里三是波多黎各继续应对新型冠状病毒19（COVID-19） 流行病这项研究将提供一个独特的机会，了解3种不同的公共卫生的影响， 紧急情况对健康和保健差距很大的少数民族人口造成影响。我们设计了一个 混合方法，多层次的研究，将三角定量和定性数据，研究前和后 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复原力、经验和 岛上的医疗保健系统。该研究将使用来自50家综合医院和20家 岛上联邦政府资助的卫生中心，对卫生系统领导人和提供者的定性访谈，以及 对一组有代表性的3 062名岛上成年居民进行了后续访谈。利用多纳本迪安式的 护理模式和概念，从一个新兴的文献卫生系统的弹性作为我们的研究框架，我们 将1）确定影响波多黎各卫生保健系统能力的因素， 从飓风玛丽亚，地震和COVID-19中恢复过来，2）模拟 多种灾害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）从以下方面吸取教训： 卫生保健领导者和提供者。我们将综合我们的三角研究方法的信息 为有效和协调的缓解方法提供数据驱动的建议， 在灾害发生频率和强度不断增加的情况下，加强备灾、救灾和抗灾能力。

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.