5 results
Assessing Hospital Disaster Readiness Over Time at the US Department of Veterans Affairs
- Claudia Der-Martirosian, Tiffany A. Radcliff, Alicia R. Gable, Deborah Riopelle, Farhad A. Hagigi, Pete Brewster, Aram Dobalian
-
- Journal:
- Prehospital and Disaster Medicine / Volume 32 / Issue 1 / February 2017
- Published online by Cambridge University Press:
- 14 December 2016, pp. 46-57
- Print publication:
- February 2017
-
- Article
- Export citation
-
Introduction
There have been numerous initiatives by government and private organizations to help hospitals become better prepared for major disasters and public health emergencies. This study reports on efforts by the US Department of Veterans Affairs (VA), Veterans Health Administration, Office of Emergency Management’s (OEM) Comprehensive Emergency Management Program (CEMP) to assess the readiness of VA Medical Centers (VAMCs) across the nation.
Hypothesis/ProblemThis study conducts descriptive analyses of preparedness assessments of VAMCs and examines change in hospital readiness over time.
MethodsTo assess change, quantitative analyses of data from two phases of preparedness assessments (Phase I: 2008-2010; Phase II: 2011-2013) at 137 VAMCs were conducted using 61 unique capabilities assessed during the two phases. The initial five-point Likert-like scale used to rate each capability was collapsed into a dichotomous variable: “not-developed=0” versus “developed=1.” To describe changes in preparedness over time, four new categories were created from the Phase I and Phase II dichotomous variables: (1) rated developed in both phases; (2) rated not-developed in Phase I but rated developed in Phase II; (3) rated not-developed in both phases; and (4) rated developed in Phase I but rated not- developed in Phase II.
ResultsFrom a total of 61 unique emergency preparedness capabilities, 33 items achieved the desired outcome – they were rated either “developed in both phases” or “became developed” in Phase II for at least 80% of VAMCs. For 14 items, 70%-80% of VAMCs achieved the desired outcome. The remaining 14 items were identified as “low-performing” capabilities, defined as less than 70% of VAMCs achieved the desired outcome.
Conclusion:Measuring emergency management capabilities is a necessary first step to improving those capabilities. Furthermore, assessing hospital readiness over time and creating robust hospital readiness assessment tools can help hospitals make informed decisions regarding allocation of resources to ensure patient safety, provide timely access to high-quality patient care, and identify best practices in emergency management during and after disasters. Moreover, with some minor modifications, this comprehensive, all-hazards-based, hospital preparedness assessment tool could be adapted for use beyond the VA.
,Der-Martirosian C ,Radcliff TA ,Gable AR ,Riopelle D ,Hagigi FA ,Brewster P .Dobalian A Assessing Hospital Disaster Readiness Over Time at the US Department of Veterans Affairs . Prehsop Disaster Med.2017 ;32 (1 ):46 –57 .
Developing Valid Measures of Emergency Management Capabilities within US Department of Veterans Affairs Hospitals
- Aram Dobalian, Judith A. Stein, Tiffany A. Radcliff, Deborah Riopelle, Pete Brewster, Farhad Hagigi, Claudia Der-Martirosian
-
- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 5 / October 2016
- Published online by Cambridge University Press:
- 05 August 2016, pp. 475-484
- Print publication:
- October 2016
-
- Article
- Export citation
-
Introduction
Hospitals play a critical role in providing health care in the aftermath of disasters and emergencies. Nonetheless, while multiple tools exist to assess hospital disaster preparedness, existing instruments have not been tested adequately for validity.
Hypothesis/ProblemThis study reports on the development of a preparedness assessment tool for hospitals that are part of the US Department of Veterans Affairs (VA; Washington, DC USA).
MethodsThe authors evaluated hospital preparedness in six “Mission Areas” (MAs: Program Management; Incident Management; Safety and Security; Resiliency and Continuity; Medical Surge; and Support to External Requirements), each composed of various observable hospital preparedness capabilities, among 140 VA Medical Centers (VAMCs). This paper reports on two successive assessments (Phase I and Phase II) to assess the MAs’ construct validity, or the degree to which component capabilities relate to one another to represent the associated domain successfully. This report describes a two-stage confirmatory factor analysis (CFA) of candidate items for a comprehensive survey implemented to assess emergency preparedness in a hospital setting.
ResultsThe individual CFAs by MA received acceptable fit statistics with some exceptions. Some individual items did not have adequate factor loadings within their hypothesized factor (or MA) and were dropped from the analyses in order to obtain acceptable fit statistics. The Phase II modified tool was better able to assess the pre-determined MAs. For each MA, except for Resiliency and Continuity (MA 4), the CFA confirmed one latent variable. In Phase I, two sub-scales (seven and nine items in each respective sub-scale) and in Phase II, three sub-scales (eight, four, and eight items in each respective sub-scale) were confirmed for MA 4. The MA 4 capabilities comprise multiple sub-domains, and future assessment protocols should consider re-classifying MA 4 into three distinct MAs.
ConclusionThe assessments provide a comprehensive and consistent, but flexible, approach for ascertaining health system preparedness. This approach can provide an organization with a clear understanding of areas for improvement and could be adapted into a standard for hospital readiness.
,Dobalian A ,Stein JA ,Radcliff TA ,Riopelle D ,Brewster P ,Hagigi F .Der-Martirosian C Developing Valid Measures of Emergency Management Capabilities within US Department of Veterans Affairs Hospitals . Prehosp Disaster Med.2016 ;31 (5 ):475 –484 .
Pre-earthquake Burden of Illness and Postearthquake Health and Preparedness in Veterans
- Claudia Der-Martirosian, Deborah Riopelle, Diana Naranjo, Elizabeth M. Yano, Lisa V. Rubenstein, Aram Dobalian
-
- Journal:
- Prehospital and Disaster Medicine / Volume 29 / Issue 3 / June 2014
- Published online by Cambridge University Press:
- 10 April 2014, pp. 223-229
- Print publication:
- June 2014
-
- Article
- Export citation
-
Background
During an earthquake, vulnerable populations, especially those with chronic conditions, are more susceptible to adverse, event-induced exacerbation of chronic conditions such as limited access to food and water, extreme weather temperatures, and injury. These circumstances merit special attention when health care facilities and organizations prepare for and respond to disasters.
MethodsThis study explores the relationship between pre-earthquake burden of illness and postearthquake health-related and preparedness factors in the US. Data from a cohort of male veterans who were receiving care at the Sepulveda Veterans Affairs Medical Center (VAMC) in Los Angeles, California USA during the 1994 Northridge earthquake were analyzed.
ResultsVeterans with one or more chronic conditions were more likely to report pain lasting two or more days, severe mental/emotional stress for more than two weeks, broken/lost medical equipment, having difficulty refilling prescriptions, and being unable to get medical help following the quake compared to veterans without chronic conditions. In terms of personal emergency preparedness, however, there was no association between burden of illness and having enough food or water for at least 24 hours after the earthquake.
ConclusionThe relationship that exists between health care providers, including both individual providers and organizations like the US Department of Veterans Affairs (VA), and their vulnerable, chronically-ill patients affords providers the unique opportunity to deliver critical assistance that could make this vulnerable population better prepared to meet their postdisaster health-related needs. This can be accomplished through education about preparedness and the provision of easier access to medical supplies. Disaster plans for those who are burdened with chronic conditions should meet their social needs in addition to their psychological and physical needs.
. ,Der-Martirosian C ,Riopelle D ,Naranjo D ,Yano E ,Rubenstein L .Dobalian A Pre-earthquake Burden of Illness and Postearthquake Health and Preparedness in Veterans . Prehosp Disaster Med.2014 ;29 (3 ):1 -7
Confidence in the Fairness of Local Public Health Systems’ Response to Disasters: The US Veterans’ Perspective
- Kevin C. Heslin, Deborah Riopelle, June L. Gin, John Ordunez, Diana E. Naranjo, Aram Dobalian
-
- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 7 / Issue 1 / February 2013
- Published online by Cambridge University Press:
- 25 April 2013, pp. 75-81
-
- Article
- Export citation
-
Objective
The effectiveness of local public health systems in emergency management depends on trust from the entire community. However, the failure of some government agencies to respond effectively to several major disasters has had a disproportionate impact on certain groups-racial/ethnic minorities, in particular-that are well-represented in the veteran population. Many veterans belong to multiple vulnerable populations at greater risk of harm during disasters. This study examines confidence that local public health systems will respond fairly to disasters in a diverse sample of US veterans.
MethodsThis study is an analysis of cross-sectional data on 5955 veterans in the 2009 California Health Interview Survey. Respondents were asked about their confidence that public health systems would respond fairly to their needs in the event of a disaster, regardless of their race/ethnicity or other personal characteristics. Multivariable regression analysis was used to identify variables on respondent characteristics that were independently associated with confidence. The hypothesis was that there would be less confidence in county public health systems among respondents who were racial/ethnic minorities, had less than a college degree, and were of low-income backgrounds.
ResultsApproximately 79% of veterans were confident that public health systems would respond fairly. The hypothesis was unsupported, with no differences in confidence by race/ethnicity, education, or income. Also, no differences were noted between men and women or between veterans with and without disabilities. However, confidence was associated with continent of birth, age, homeownership, and marital status.
ConclusionIf confidence affects veterans’ willingness to accept disaster preparedness communications or to give proper consideration to recommended emergency countermeasures, then local health departments that issue such information to veterans are not likely to encounter barriers by race/ethnicity, income, education, disability status, or gender.(Disaster Med Public Health Preparedness. 2013;7:75-81)
Impact of the Northridge Earthquake on the Mental Health of Veterans: Results From a Panel Study
- Aram Dobalian, Judith A. Stein, Kevin C. Heslin, Deborah Riopelle, Brinda Venkatesh, Andrew B. Lanto, Barbara Simon, Elizabeth M. Yano, Lisa V. Rubenstein
-
- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 5 / Issue S2 / September 2011
- Published online by Cambridge University Press:
- 08 April 2013, pp. S220-S226
-
- Article
- Export citation
-
Objective: The 1994 earthquake that struck Northridge, California, led to the closure of the Veterans Health Administration Medical Center at Sepulveda. This article examines the earthquake's impact on the mental health of an existing cohort of veterans who had previously used the Sepulveda Veterans Health Administration Medical Center.
Methods: From 1 to 3 months after the disaster, trained interviewers made repeated attempts to contact participants by telephone to administer a repeated measures follow-up design survey based on a survey that had been done preearthquake. Postearthquake data were obtained on 1144 of 1800 (64%) male veterans for whom there were previous data. We tested a predictive latent variable path model of the relations between sociodemographic characteristics, predisaster physical and emotional health measures, and postdisaster emotional health and perceived earthquake impact.
Results: Perceived earthquake impact was predicted by predisaster emotional distress, functional limitations, and number of health conditions. Postdisaster emotional distress was predicted by preexisting emotional distress and earthquake impact. The regression coefficient from earthquake impact to postearthquake emotional distress was larger than that of the stability coefficient from preearthquake emotional distress. Postearthquake emotional distress also was affected indirectly by preearthquake emotional distress, health conditions, younger age, and lower socioeconomic status.
Conclusions: The postdisaster emotional health of veterans who experienced greater earthquake impact would have likely benefited from postdisaster intervention, regardless of their predisaster emotional health. Younger veterans and veterans with generally poor physical and emotional health were more vulnerable to greater postearthquake emotional distress. Veterans of lower socioeconomic status were disproportionately likely to experience more effects of the disaster because they had more predisaster emotional distress, more functional limitations, and a greater number of health conditions. Because many veterans use non–Department of Veterans Affairs (VA) health care providers for at least some of their health needs, future disaster planning for both VA and non-VA providers should incorporate interventions targeted at these groups.
(Disaster Med Public Health Preparedness. 2011;5:S220-S226)