SAFEHAVEN: Decision Support for Nursing Home Resident Disaster Evacuations

描述（由申请人提供）： 通过对疗养院中脆弱老人的健康评估促进疏散的战略方法（SAFE HAVEN研究）。自2001年9月11日事件以来，数十亿联邦资金已用于改善国家的准备状态和公共卫生基础设施。大部分注意力集中在传统的第一响应者（即消防，警察，EMS）和医院准备，而不是在非急性医疗保健设施，如疗养院（NH）的准备。为易受伤害人口制定应急计划是社区备灾的一个主要内容，老年人是最易受伤害的群体。NH居民特别脆弱，因为他们有广泛的护理需求，因此与灾害相关的风险更高。然而，国家卫生机构历来没有被纳入任何一级的灾害规划，这一缺陷必须得到纠正，以避免与卡特里娜和丽塔飓风有关的悲惨事件再次发生，并防止在飓风必然袭击时发生类似的悲剧。我们的建议是对NIH计划公告06-454“灾害与健康行为研究”的直接回应。该公告呼吁开展可直接用于发展公共卫生结构和干预措施的应用研究，以解决目前对为弱势老年人服务的保健机构缺乏关注的问题。使用医疗保险索赔，季度NH居民评估数据，纵向设施文件和地理编码的数据，每个飓风袭击佛罗里达和墨西哥湾沿岸各州在2004年和2007年之间，我们建议估计飓风对NH居民的发病率和死亡率的影响。此外，使用养老院和预测的飓风路径之间的距离作为工具，我们将估计疏散或避难所的决定对居民的结果的影响。研究结果的传播将通过主要的医学和公共卫生期刊以及包括网站在内的更实用和面向从业人员的渠道进行。我们还将召集一个与年度飓风峰会相关的利益相关者咨询小组，协助我们传播结果，以最大限度地提高州养老院监管机构和应急响应协调官员对研究结果的警觉性。 公共卫生相关性：飓风对疗养院的居民有毁灭性的影响，因为他们可能会受到不利影响，无论是被转移到另一个设置或庇护的地方。利用现有的养老院数据从多个来源，这项研究旨在了解飓风和疏散决定的后果，提供第一个证据基础，告知疏散指南的创建。

DESCRIPTION (provided by applicant): Strategic Approach to Facilitating Evacuation by Health Assessment of Vulnerable Elderly in Nursing Homes (SAFE HAVEN Study). Since the events of September 11th 2001, billions of federal dollars have been devoted to improving the country's preparedness posture and public health infrastructure. Most of the attention has focused on traditional first responders (i.e. fire, police, EMS) and hospital preparedness and less to preparedness among non-acute healthcare facilities such as nursing homes (NH). Emergency planning for vulnerable populations constitutes a major element of community disaster preparedness and the elderly represent a most vulnerable group. NH residents are especially vulnerable, as they have extensive care needs and therefore, higher disaster-associated risks. However, NHs have not traditionally been incorporated into disaster planning at any level, a deficiency that must be remedied to avert a recurrence of the tragic events that occurred in connection with Hurricanes Katrina and Rita and to prevent similar tragedies when hurricanes are bound to strike. Our proposal is a direct response to NIH Program Announcement 06-454 "Behavioral Research on Disasters and Health". The announcement calls for applied research that can be directly utilized in the development of public health structures and interventions designed to redress the current lack of attention focused on health care institutions that serve the vulnerable elderly. Using Medicare claims, quarterly NH resident assessment data, longitudinal facility files and geo-coded data on each hurricane hitting Florida and the Gulf coast states between 2004 and 2007, we propose to estimate the impact of hurricanes on NH residents' morbidity and mortality. Furthermore, using the distance between the nursing home and the predicted path of the hurricane as an instrument, we will estimate the effect of the decision to evacuate or shelter in place on residents' outcomes. Dissemination of study findings will be designed for major medical and public health journals as well as more applied and practitioner oriented outlets including web sites. We will also convene an advisory group of stakeholders associated with the annual Hurricane Summit to assist us with dissemination of results to maximize the likelihood that both state nursing home regulators as well as emergency response coordination officials are alerted to the results of the study. PUBLIC HEALTH RELEVANCE: Hurricanes have a devastating effect on nursing home residents since they may be adversely affected either by being transferred to another setting or by sheltering in place. Using existing nursing home data from multiple sources, this study seeks to understand the consequences of hurricanes and evacuation decisions, providing the first evidence base to inform the creation of evacuation guidelines.