Medical care recovery and resiliency after disaster

In addition to the loss of life, property damage and displacement of populations brought about by disasters, there are serious impacts on health care through factors such as increased demand for medical care, loss of facilities and equipment and disrupted ongoing and preventive care appointments, which can harm continuity of care. Although it seems obvious that medical practices and appointments would be disrupted by disasters, there is little detail on how much disruption disasters cause, how medical practices recover and how resilient different clinics and practices are. These are crucial things to understand to better serve patients, particularly those in vulnerable populations.

A new study led by Tiffany Radcliff, PhD, associate professor and associate department head of the Health Policy and Management department at the Texas A&M School of Public Health, helps fill in some of those gaps analyzing how a disaster affected medical care and the recovery and resiliency of medical practices. In this study, published in the Journal of the American Board of Family Medicine, Radcliff and her colleagues from the Veterans Emergency Management Evaluation Center (VEMEC) used appointment data from multiple U.S. Department of Veterans Affairs (VA) clinics in the Gulf Coast region during a 25-week period around a category 4 hurricane.

They compared missed and completed appointments at VA medical centers and clinics in areas that were directly affected by the hurricane to areas that were not affected during the 12 weeks prior to hurricane landfall, the week that the hurricane hit and the 12 weeks following landfall. The two measures of interest for the research team were recovery, the amount of time needed for patients whose appointments were canceled by the clinic to complete their appointments and resiliency—the change in the proportion of completed and missed appointments during the study’s timeframe.

The research team’s dataset included more than a million appointment records for more than 250,000 patients, with 25 percent of the appointments at clinics affected by the hurricane and 75 percent outside of the area hit. Primary care appointments saw a slight decrease in the amount of time to complete cancelled appointments after the storm compared to beforehand. Mental health appointments saw a slight increase in recovery time after the hurricane and other specialties had mixed results. Areas that were not affected by the hurricane had consistent completion rates before and after. However, several clinics in areas affected by the storm saw large changes in resiliency, with those clinics closer to the coast being more adversely affected than clinics farther inland.

“This study’s findings show that appointment data can improve real-time understanding of how a disaster is affecting medical care and help target vulnerable patients to reduce their risks of disrupted care,” Radcliff said. “The methods are flexible enough to be tailored to a variety of health systems and simple enough to help with the often-complex task of planning how to schedule and reschedule routine care around disasters.”

Radcliff and colleagues have taken an initial step into better understanding and managing how disasters affect health care; however, future work is needed to improve things further. They note that this study was limited because it focused on a single and relatively short-term disruption. Further research should look into shorter and longer-term disruptions and compare disasters that come with advanced warning like hurricanes and those without warning like earthquakes or tornadoes. Another future avenue of study Radcliff and colleagues identify is an exploration of how shared resources and linked medical records among clinics within larger health care systems affect recovery and resiliency. Lastly, they hope to extend the analysis to other health care systems since their study focused on VA clinics, which have a unique patient base, and different health care systems may have other strategies for emergency preparedness and response.

“The future work made possible by this initial study promises improvements to medical care following disasters, especially for vulnerable populations,” Radcliff said. “Increases in both population and disaster frequency makes an improved understanding of disaster consequences for the health care delivery system a vital part of overall disaster recovery.”