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

• 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
• 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

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).

项目摘要/摘要 USVI在2017年9月被两个成功的5类飓风袭击：飓风Irma 和玛丽亚。风暴对岛屿造成了巨大破坏，包括部分破坏 施耐德地区医疗中心（SRMC），圣托马斯唯一的医院，可用 从169到<40的床，其癌症中心和心脏导管实验室的破坏并减少 呼吸支持，CT和MRI功能。提供医疗服务的提供进一步受到了阻碍 医师和其他医务人员的近亲和后与后与赫里里奇相关的出发事件。与人的人 空中救护车继续将最严重的条件发送给美国持续美国的医院 与其他人一起回到社区崩溃了初级保健，公共卫生和社交网络。 岛上仍然有医生的看法，死亡率上升了， 尤其是在贫穷的老年患者中：用一个物理学的话说：“他们只是 放弃并垂死。” 当前的提案旨在提供文档并增加对简短和的理解 2017年飓风的长期健康风险和影响，重点关注SRMC急诊室 作为圣托马斯邮政赫里卡尼医疗服务的主要访问点。研究将评估急性 与飓风相关的医疗状况以及在A）严重的情况下的慢性疾病加剧 破坏医疗服务； b）个体患者因素； c）与文化相关的社会崩溃 支持网络，特别是针对老龄化患者的网络。数据将为急性干预以及 长期灾难管理计划以促进弹性，并将进食随后的建模 努力集中在USVI圣托马斯的非洲加勒比地区人口所特有的方面。具体目标 包括： AIM1：表征医学的差异（诊断，合并症，存在/不存在慢性 疾病，死亡率）和人口统计学因素（年龄，性别，种族/种族，SES，付款人身份） 和赫里纳人，并通过处置（空中救护车转移；医院入院，退出 社区）。 AIM 2：关注300名55岁以上的疾病后ED患者患有慢性医疗疾病 两次回到社区（12个月和24个月），以表征他们的人口统计学（年龄， 性别，种族/种族）；医疗保健利用（初级保健访问）；医疗（合并症）；行为 （医学依从性，应对风格，抑郁，自我报告的韧性）和社交网络状况和 确定这些因素与结果的关联（死亡，再入院或医院；功能 地位）。