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

三起公共卫生灾难前后的波多黎各医疗系统

基本信息

批准号：
10626057
负责人：
GLORISA J CANINO
金额：
$ 63.44万
依托单位：
DREXEL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-23 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10626057
关键词：
Accident and Emergency department Adult Affect Asthma Back Businesses COVID-19 COVID-19 pandemic Caring Cellular Phone Chronic Care Clinic Clinics and Hospitals Communicable Diseases Communities Community Health Data Diabetes Mellitus Dialysis procedure Disasters Earthquakes Electricity Elements Emergency Situation Environmental Hazards Epidemic Equipment Event Floods Frequencies Funding General Hospitals Government Health Health Personnel Health Policy Health Services Accessibility Health care facility Health system Healthcare Healthcare Systems Homelessness Hospitals Hurricane Infrastructure Insurance Coverage Interview Island Learning Left Literature Long-Term Effects Measures Medicaid Medical Methods Minority Groups Modeling Natural Disasters Occupations Operative Surgical Procedures Out-Migrations Ownership Patients Pharmaceutical Preparations Pharmacy facility Phase Poverty Preventive care Privatization Provider Public Health Publishing Puerto Rican Puerto Rico Quality of Care Readiness Recommendation Recovery Research Resources Risk Management Rural Sampling Series Services Source Stress Surveys System Time Unemployment Uninsured Water analytical method barrier to care burden of illness burnout care systems cohort community clinic design experience follow-up health care availability health care delivery health care disparity health care service health care service utilization health disparity health disparity populations informant insurance claims medical supply negative affect novel coronavirus pandemic disease patient-level barriers public health emergency resilience response trend

项目摘要

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.

项目摘要/摘要包括飓风，地板和地震在内的强烈自然灾害变得越来越频繁，近年来的间距紧密。大规模的自然灾害会严重损害并降低医疗保健设施结构完整性和设备，造成环境危害并对健康服务产生负面影响分娩（例如，取消手术；推迟预防保健；药房关闭；人员配备，药物和医疗供应短缺；急诊室量的大量瞬态激增） - 所有这些都有助于医疗保健提供者的压力增加。自然上的叠加传染病发作灾难进一步加剧了对医疗保健系统的压力。在3年的时间里，波多黎各遭受了苦难来自3个主要的背靠背公共卫生紧急情况，其中包括2种自然灾害和一次大流行。第一的，玛丽亚飓风于2017年9月袭击，造成了整个岛上的重大破坏。社区失去了获得电力，饮用水，安全道路和桥梁以及医疗保健等基本服务。最多该岛的公共和私人医疗保健机构已关闭或几个月的能力有限。第二，在 2019年12月，一系列超过500个地震2.0或更高的波多黎各引起的对许多苦苦挣扎的医疗机构的更多基础设施损害，并留下数千个无家可归者或生活在他们的院子里。第三，波多黎各继续处理新颖的冠状病毒19（covid-19）大流行。这项研究将提供一个独特的机会来了解3个不同的公共卫生的影响对健康和医疗保健分布的少数族裔人口的紧急情况。我们设计了一个混合方法，多层研究，将三角定量和定性数据研究前后这三个公共卫生紧急情况对波多黎各的医疗保健系统的准备，反应和恢复工作以及紧急情况如何影响弹性，经验和利用岛的医疗保健系统。该研究将使用来自50家普通医院和20个的行政利用数据该岛的联邦卫生中心，卫生系统领导者和提供者的定性访谈以及 3,062个岛屿成年居民的代表队列的后续访谈。使用Donabedian质量有关卫生系统弹性作为我们的学习框架的新兴文献中的护理模型和概念，我们将1）确定影响波多黎各医疗保健系统准备能力的因素，做出回应从玛丽亚飓风中恢复，地震和covid-19，2）建模关于卫生系统弹性以及这些影响如何相互作用的多次灾难，以及3）从中学到的教训医疗保健领导者和提供者。我们将从三角研究方法中综合信息为了提供数据驱动的建议，以进行有效和协调的缓解方法，在增加灾难的频率和强度的条件下，准备性，反应和弹性。