Impacts of the 2017 Hurricanes on Emergency Department Admissions and Outcomes in St. Thomas, USVI

2017 年飓风对美属维尔京群岛圣托马斯市急诊科入院和结果的影响

基本信息

批准号：
9976593
负责人：
John Glenn Morris
金额：
$ 18.98万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-11 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9976593
关键词：
Accident and Emergency department Acute Adherence Admission activity Age Aging Air Air Ambulances Back Beds Behavioral Cancer Center Cardiac Catheterization Procedures Caribbean region Caring Categories Cessation of life Chronic Chronic Disease Communities Data Demographic Factors Diagnosis Diagnostic Disasters Disease Documentation Elderly Emergency Department patient Ethnic Origin Future Gender Health Health Personnel Health Services Hospitalization Hospitals Hurricane Intervention Island Laboratories Locales Magnetic Resonance Imaging Medical Medical center Mental Depression Minority Modeling Morbidity - disease rate Outcome Patient Self-Report Patients Perception Persons Phase Physicians Population Primary Health Care Public Health Race Recovery Risk Services Social Network Social support Time United States United States Virgin Islands Visit Work comorbidity coping functional status health care service health care service utilization hospital readmission individual patient mortality older patient patient population resilience respiratory response

项目摘要

Project Summary/Abstract The USVI was hit by two successive, Category 5 hurricanes in September 2017: Hurricanes Irma and Maria. The storms caused massive damage on the islands, including partial destruction of the Schneider Regional Medical Center (SRMC), the only hospital on St. Thomas, with a reduction in available beds from 169 to <40, destruction of its Cancer Center and heart catheterization laboratories and reduced respiratory support, CT, and MRI capabilities. Provision of medical services has been further hampered by pre- and post-hurricane related departures of physicians and other medical personnel. Persons with the most serious conditions continue to be sent by air ambulance to hospitals in the continental United States, with others discharged back to the community to collapsed primary care, public health, and social networks. There was a perception on the part of physicians remaining on the island that mortality rates were up, particularly among poor, elderly patients with chronic conditions: in the words of one physician, “they're just giving up and dying.” The current proposal seeks to provide documentation and increase understanding of the short and long term health risks and impacts of the 2017 hurricanes, focusing on the SRMC Emergency Department as the primary access point for medical care on St. Thomas post-hurricane. Studies will assess acute hurricane-related medical conditions and the exacerbation of chronic diseases in the setting of a) severely disrupted health care services; b) individual patient factors; and c) a collapse of culturally-relevant social support networks, particularly for aging patients. Data will provide a basis for acute interventions as well as long-term disaster management planning to promote resilience, and will feed into subsequent modeling efforts focused on aspects unique to the Afro-Caribbean population of St. Thomas, USVI. Specific Aims include: Aim1: Characterize the differences in medical (diagnosis, co-morbidities, presence/absence of chronic disease, mortality) and demographic factors (age, gender, race/ethnicity, SES, payer status) for periods pre- and post-hurricanes, and by disposition (air ambulance transfer; hospital admission, discharge back to community). Aim 2: Follow 300 post-disaster ED patients ages 55+ with chronic medical diseases who were discharged back to the community at two time epochs (12 and 24 months) to characterize their demographic (age, gender, race/ethnicity); health care utilization (primary care visits); medical (co-morbidities); behavioral (medical adherence, coping style, depression, self-reported resilience) and social network status and identify the association of these factors with outcome (death, readmission to ED or hospital; functional status).

项目概要/摘要 2017 年 9 月，美属维尔京群岛连续遭受两次 5 级飓风袭击：飓风艾尔玛风暴对岛屿造成了巨大破坏，包括部分毁坏。施耐德地区医疗中心 (SRMC)，圣托马斯岛唯一一家医院，可用资源减少床位从 169 个减少到 <40 个，摧毁其癌症中心和心导管实验室并减少呼吸支持、CT 和 MRI 能力的提供进一步受到阻碍。医生和其他医务人员在飓风前和飓风后离开。最严重的情况继续通过空中救护车送往美国大陆的医院，其他人则出院回到社区，初级保健、公共卫生和社交网络都崩溃了。留在岛上的医生认为死亡率上升了，特别是对于患有慢性病的贫困老年患者：用一位医生的话说，“他们只是放弃并死去。” 当前的提案旨在提供文件并增进对短期和 2017 年飓风的长期健康风险和影响，重点关注 SRMC 急诊部作为圣托马斯飓风后医疗护理的主要接入点研究将评估急性情况。与飓风相关的医疗状况以及严重情况下慢性疾病的恶化）医疗保健服务中断；b) 患者个体因素；以及 c) 文化相关的社会崩溃支持网络，特别是针对老年患者的数据将为紧急干预和治疗提供基础。长期灾害管理规划，以提高抵御能力，并将纳入后续建模工作重点是美属维尔京群岛圣托马斯的非洲裔加勒比人口特有的方面。包括：目标 1：描述医学方面的差异（诊断、合并症、存在/不存在慢性病）疾病、死亡率）和人口因素（年龄、性别、种族/民族、社会经济地位、付款人状况）和飓风过后，以及处置（空中救护车转运；入院、出院返回社区）。目标 2：追踪 300 名 55 岁以上患有慢性疾病的灾后 ED 出院患者在两个时期（12 个月和 24 个月）返回社区来描述他们的人口特征（年龄、性别、种族/民族）；医疗保健利用（初级保健就诊）；（医疗依从性、应对方式、抑郁、自我报告的适应力）和社交网络状态确定这些因素与结果（死亡、再次入院或住院；功能性地位）。