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Impact of Superstorm Sandy on Medicare Patients’ Utilization of Hospitals and Emergency Departments

Published on Oct 18, 2017in Western Journal of Emergency Medicine
· DOI :10.5811/westjem.2017.7.34730
Benoit Stryckman , Lauren Walsh7
Estimated H-index: 7
+ 2 AuthorsNicole Lurie52
Estimated H-index: 52
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Abstract
Author(s): Stryckman, Benoit; Walsh, Lauren; Carr, Brendan; Hupert, Nathaniel; Lurie, Nicole | Abstract: Introduction: National health security requires that healthcare facilities be prepared to provide rapid,effective emergency and trauma care to all patients affected by a catastrophic event. We sought toquantify changes in healthcare utilization patterns for an at-risk Medicare population before, during,and after Superstorm Sandy’s 2012 landfall in New Jersey (NJ).Methods: This study is a retrospective cohort study of Medicare beneficiaries impacted bySuperstorm Sandy. We compared hospital emergency department (ED) and healthcare facilityinpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20%random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012(N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay,service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission.Results: In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prioryear. In the post-storm week, ED visits increased by 14% statewide; of these additional “surge”patients, 20% were admitted to the hospital. The increase in ED demand was more than double thestatewide average in the most highly impacted coastal regions (35% versus 14%).Conclusion: Superstorm Sandy impacted both pre- and post-storm patient movement in NewJersey; post-landfall ED surge was associated with overall storm impact, which was greatest incoastal counties. A significant increase in the number and severity of pre-storm transfer patients,in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attentionto the importance of collaborative regional approaches to healthcare in large-scale events.
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References11
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Published on Jan 1, 2016
Allison Crimmins6
Estimated H-index: 6
,
Hawkins1
Estimated H-index: 1
+ 13 AuthorsLewis H. Ziska11
Estimated H-index: 11
Published on Sep 1, 2015in Journal of The American College of Surgeons4.45
Peter C. Jenkins1
Estimated H-index: 1
(IUPUI: Indiana University – Purdue University Indianapolis),
Caroline R. Richardson35
Estimated H-index: 35
(UM: University of Michigan)
+ 4 AuthorsMark R. Hemmila34
Estimated H-index: 34
(UM: University of Michigan)
Background Increases in trauma patient volume and acuity, such as during mass casualty events, can overwhelm hospitals, potentially worsening patient outcomes. Due to methodological limitations, the effect of trauma surges on clinical outcomes remains unclear, so hospitals have not prepared for such events in an evidence-based manner. The objective of this study was to develop a new measure of hospital capacity strain corresponding to trauma admissions and to examine the relationship between tra...
Published on Jan 1, 2015in American Journal of Kidney Diseases6.65
Jeffrey Kelman4
Estimated H-index: 4
(HHS: United States Department of Health and Human Services),
Kristen Finne2
Estimated H-index: 2
(Office of the Assistant Secretary for Preparedness and Response)
+ 5 AuthorsNicole Lurie52
Estimated H-index: 52
(Office of the Assistant Secretary for Preparedness and Response)
Background Hurricane Sandy affected access to critical health care infrastructure. Patients with end-stage renal disease (ESRD) historically have experienced problems accessing care and adverse outcomes during disasters. Study Design Retrospective cohort study with 2 comparison groups. Setting & Participants Using Centers for Medicare & Medicaid Services claims data, we assessed the frequency of early dialysis, emergency department (ED) visits, hospitalizations, and 30-day mortality for patients...
Published on Dec 10, 2014in JAMA51.27
Justin B. Dimick62
Estimated H-index: 62
,
Andrew M. Ryan37
Estimated H-index: 37
(UM: University of Michigan)
Published on Jul 1, 2014in Annals of Emergency Medicine5.21
Amesh A. Adalja10
Estimated H-index: 10
(University of Pittsburgh),
Matthew Watson7
Estimated H-index: 7
+ 3 AuthorsEric Toner11
Estimated H-index: 11
Study objective: Hospital evacuations have myriad effects on all elements of the health care system. We seek to (1) examine the effect of patient surge on hospitals that received patients from evacuating hospitals in New York City during Hurricane Sandy; (2) describe operational challenges those hospitals faced pre- and poststorm; and (3) examine the coordination efforts to distribute patients to receiving hospitals. Methods: We used a qualitative, interview-based method to identify medical surg...
Noah S. Diffenbaugh46
Estimated H-index: 46
(Stanford University),
Martin Scherer7
Estimated H-index: 7
(Stanford University),
Robert J. Trapp25
Estimated H-index: 25
(Purdue University)
Although severe thunderstorms are one of the primary causes of catastrophic loss in the United States, their response to elevated greenhouse forcing has remained a prominent source of uncertainty for climate change impacts assessment. We find that the Coupled Model Intercomparison Project, Phase 5, global climate model ensemble indicates robust increases in the occurrence of severe thunderstorm environments over the eastern United States in response to further global warming. For spring and autu...
Published on Jun 1, 2013in Annals of Emergency Medicine5.21
Benjamin Chih-An Sun1
Estimated H-index: 1
(OHSU: Oregon Health & Science University),
Renee Y. Hsia32
Estimated H-index: 32
(UCSF: University of California, San Francisco)
+ 5 AuthorsSteven M. Asch63
Estimated H-index: 63
(VA Palo Alto Healthcare System)
Study objective: Emergency department (ED) crowding is a prevalent health delivery problem and may adversely affect the outcomes of patients requiring admission. We assess the association of ED crowding with subsequent outcomes in a general population of hospitalized patients. Methods: We performed a retrospective cohort analysis of patients admitted in 2007 through the EDs of nonfederal, acute care hospitals in California. The primary outcome was inpatient mortality. Secondary outcomes included...
Published on Jan 22, 2010in Science41.04
Morris A. Bender18
Estimated H-index: 18
(NOAA: National Oceanic and Atmospheric Administration),
Thomas R. Knutson44
Estimated H-index: 44
(NOAA: National Oceanic and Atmospheric Administration)
+ 4 AuthorsIsaac M. Held70
Estimated H-index: 70
(NOAA: National Oceanic and Atmospheric Administration)
Several recent models suggest that the frequency of Atlantic tropical cyclones could decrease as the climate warms. However, these models are unable to reproduce storms of category 3 or higher intensity. We explored the influence of future global warming on Atlantic hurricanes with a downscaling strategy by using an operational hurricane-prediction model that produces a realistic distribution of intense hurricane activity for present-day conditions. The model projects nearly a doubling of the fr...
John L. Hick21
Estimated H-index: 21
,
Kristi L. Koenig21
Estimated H-index: 21
+ 1 AuthorsTareg Bey13
Estimated H-index: 13
Facility-based health care personnel often lack emergency management training and experience, making it a challenge to efficiently assess evolving incidents and rapidly mobilize appropriate resources. We propose the CO-S-TR model, a simple conceptual tool for hospital incident command personnel to prioritize initial incident actions to adequately address key components of surge capacity. There are 3 major categories in the tool, each with 4 subelements. “CO” stands for command, control, communic...
Asher Hirshberg30
Estimated H-index: 30
(BCM: Baylor College of Medicine),
Bradford G. Scott14
Estimated H-index: 14
(BCM: Baylor College of Medicine)
+ 3 AuthorsMichael Stein18
Estimated H-index: 18
Background: The aim of this modeling study was to examine how casualty load affects the level of trauma care in multiple casualty incidents and to define the surge capacity of the hospital trauma assets. Methods: The disaster plan of a U.S. Level I trauma center was translated into a computer model and challenged with simulated casualties based on 223 patients from 22 bombing incidents treated at an Israeli hospital. The model assigns providers and facilities to casualties and computes the level...
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