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.

项目摘要 玛丽亚飓风是现代历史上最严重的自然灾害之一。玛丽亚引起了估计的 3,000人死亡和1,390亿美元损害该岛的基础设施。玛丽亚飓风延长了 电力停电阻止肾脏衰竭的人获得护理。大多数肾脏患者 失败每周三次在门诊透析设施中接受血液透析。玛丽亚期间进入透析 波多黎各的某些地区有限或不存在，有些患者需要前往其他设施 在岛上或美国大陆接受护理。玛丽亚可能破坏了常规透析护理，导致 增加死亡，住院或其他不良事件的风险。要了解 鉴于社会和 医疗保健不平等，以及玛丽亚在岛上造成的广泛破坏水平。使用纵向 美国肾脏数据系统的所有透析患者的数据以及与 提供者和诊所工作人员，我们的具体目标如下：1）检查长期移民的长期趋势 波多黎各，前后玛丽亚的肾衰竭的人。我们工作的假设是 玛丽亚飓风增加了肾衰竭患者的迁移，相对于疾病前时期。 2） 估计玛丽亚飓风对移民和非移民死亡率和住院的长期影响 肾衰竭，玛丽亚前后的移民患者。我们的工作假设是，跟随玛丽亚， 在波多黎各以外迁移的人将经历增加死亡率和住院 与没有从波多黎各迁移的人相比； 3）检查透析提供者的策略和 感知的障碍可以减轻飓风对肾脏衰竭患者的影响，并了解长期 通过定性访谈对透析提供者组织和员工的期限后果。我们期望 这些访谈将提供深入的新颖见解，以了解提供者保持护理连续性和的策略 避免透析设施关闭。该提案是对FOA（PA-20-172）的直接回应“长期影响 为健康差异人群服务的医疗保健系统灾难。 更广泛地了解玛丽亚飓风对复杂人群的影响。提议 项目与NIMHD感兴趣的领域保持一致，包括美国领土，社会经济处境不利 人口以及理解自然灾害对长期影响的总体目标 健康差异人群和为他们服务的医疗保健系统。我们为患者使用纵向数据 患有丰富的临床和社会经济协变量，透析（自2010年以来约有14,000名患者）允许我们 跟踪迁移模式，死亡率和住院结果以及与提供者的定性访谈 和诊所工作人员。我们的研究将提供有关策略的证据，包括改善患者的迁移 肾衰竭患者自然灾害后，获得护理和健康结果。