Long-Term Effects of Hurricane Maria on Healthcare Delivery, Migration and Mortality Among People with Kidney Failure in Puerto Rico

飓风玛丽亚对波多黎各肾衰竭患者的医疗服务、移民和死亡率的长期影响

• 批准号: 10661498
• 负责人: Maricruz Rivera-Hernandez
• 金额: $ 46.25万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-07 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10661498
• 关键词: Adopted; Adverse event; Area; Caring; Cessation of life; Chronically Ill; Clinic; Clinical; Complex; Continuity of Patient Care; Data; Decision Making; Dialysis patients; Dialysis procedure; Disasters; Economically Deprived Population; Elderly; Electricity; Emergency department visit; Goals; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hemodialysis; Hospitalization; Hospitals; Hurricane; Information Systems; Infrastructure; Interview; Island; Kidney; Kidney Failure; Long-Term Effects; Longitudinal Studies; Longitudinal trends; Migrant; Modernization; Morbidity - disease rate; National Institute on Minority Health and Health Disparities; Natural Disasters; Nonmigrant; Out-Migrations; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Pattern; Persons; Policies; Population; Provider; Public Health; Puerto Rican; Puerto Rico; Readiness; Recording of previous events; Research; Research Methodology; Role; Services; Specialist; Telephone; Travel; Vulnerable Populations; Work; complex chronic conditions; drinking water; experience; health care availability; health care delivery; health care disparity; health disparity populations; hospitalization rates; improved; insight; interest; medical specialties; migration; mortality; mortality risk; novel; outcome disparities; poor health outcome; prevent; research study; response; social; socioeconomic disadvantage; socioeconomics; vulnerable community

PROJECT SUMMARY Hurricane Maria was one of the worst natural disasters in modern US history. Maria caused an estimated 3,000 deaths and $139 billion in damage to the Island's infrastructure. Hurricane Maria caused prolonged electricity outages that prevented people with kidney failure from accessing care. Most patients with kidney failure receive hemodialysis at outpatient dialysis facilities three times a week. Access to dialysis during Maria was limited or non-existent in some areas in Puerto Rico, and some patients needed to travel to other facilities on the island or to the US mainland to receive care. Maria may have disrupted regular dialysis care, leading to increased risk of death, hospitalization, or other adverse events. There is a crucial need to understand the consequences of this large-scare natural disaster among this vulnerable population, given social and healthcare inequalities, and the extensive level of destruction caused by Maria on the island. Using longitudinal data for all dialysis patients in Puerto Rico from the US Renal Data System and qualitative interviews with providers and clinic staff, our specific aims are as follows: 1) Examine long-term trends in outmigration among persons with kidney failure in Puerto Rico, pre- and post-Hurricane Maria. Our working hypothesis is that Hurricane Maria increased out-migration of kidney failure patients relative to the pre-disaster period; 2) Estimate the long-term impact of Hurricane Maria on mortality and hospitalizations among migrant and non- migrant patients with kidney failure, pre- and post-Maria. Our working hypothesis is that following Maria, persons who migrated outside of Puerto Rico will experience increased mortality and hospital admissions compared to persons who did not migrate out of Puerto Rico; and 3) Examine dialysis providers' strategies and perceived barriers to mitigating the Hurricane's effects on patients with kidney failure and understand the long- term consequences for dialysis provider organizations and staff through qualitative interviews. We expect these interviews will provide in-depth, novel insights into providers' strategies to maintain continuity of care and avoid dialysis facility closures. This proposal is a direct response to the FOA (PA-20-172) “Long-Term Effects of Disasters on Health Care Systems Serving Health Disparity Populations.” This proposal is a first step towards a broader understanding of the impact of Hurricane Maria on complex populations. The proposed project aligns with the NIMHD areas of interest, including U.S. territories, socioeconomically disadvantaged populations, as well as the overarching goal of understanding the long-term effects of natural disasters on health disparity populations and the health care systems that serve them. We use longitudinal data for patients undergoing dialysis (~14,000 patients since 2010) with rich clinical and socioeconomic covariates that allow us to track migration patterns and mortality and hospitalization outcomes and qualitative interviews with providers and clinic staff. Our study will provide evidence on the strategies, including migration that improves patient access to care and health outcomes following a natural disaster among patients with kidney failure.

项目总结