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Comparing Primary Health-Care Service Delivery Disruptions Across Disasters

Published online by Cambridge University Press:  17 August 2021

Tiffany A. Radcliff*
Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, California, USA Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas, USA
Karen Chu
Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, California, USA
Claudia Der-Martirosian
Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, California, USA
Aram Dobalian
Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, California, USA Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, Tennessee, USA
Corresponding author: Tiffany A. Radcliff, Email:



The aim of this study was to compare primary care appointment disruptions around Hurricanes Ike (2008) and Harvey (2017) and identify patterns that indicate differing continuity of primary care or care systems across events.


Primary care appointment records covering 5 wk before and after each storm were identified for Veterans Health Affairs (VA) facilities in the greater Houston and surrounding areas and a comparison group of VA facilities located elsewhere. Appointment disposition percentages were compared within and across storm events to assess care disruptions.


For Hurricane Harvey, 14% of primary care appointments were completed during the week of landfall (vs 33% for Hurricane Ike and 69% in comparison clinics), and 49% were completed the following week (vs 58% for Hurricane Ike and 71% for comparison clinics). By the second week after Hurricane Ike and third week after Harvey, the scheduled appointment completion percentage returned to prestorm levels of approximately 60%.


There were greater and more persistent care disruptions for Hurricane Harvey relative to Hurricane Ike. As catastrophic emergencies including major natural disasters and infectious disease pandemics become a more recognized threat to primary and preventive care delivery, health-care systems should consider implementing strategies to monitor and ensure primary care appointment continuity.

Brief Report
© Society for Disaster Medicine and Public Health, Inc. 2021

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