Stryckman Benoit, Walsh Lauren, Carr Brendan G, Hupert Nathaniel, Lurie Nicole
U.S. Department of Health and Human Services, Washington, D.C.
Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, Pennsylvania.
West J Emerg Med. 2017 Oct;18(6):1035-1041. doi: 10.5811/westjem.2017.7.34730. Epub 2017 Sep 21.
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 to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy's 2012 landfall in New Jersey (NJ).
This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient 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.
In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. 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 the statewide average in the most highly impacted coastal regions (35% versus 14%).
Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal 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 attention to the importance of collaborative regional approaches to healthcare in large-scale events.
国家卫生安全要求医疗机构做好准备，为所有受灾难性事件影响的患者提供快速、有效的紧急和创伤护理。我们试图量化2012年超级风暴桑迪登陆新泽西州（NJ）之前、期间和之后，处于风险中的医疗保险人群的医疗服务利用模式变化。
本研究是一项对受超级风暴桑迪影响的医疗保险受益人的回顾性队列研究。我们使用2011年和2012年持续参保的20%医疗保险按服务付费受益人的随机样本（N = 224,116），比较了超级风暴桑迪登陆前后几周医院急诊科（ED）和医疗机构住院服务的利用情况。结果指标包括风暴前出院（或转院）、平均住院时间、服务强度权重以及风暴后导致出院或住院的急诊科就诊情况。
在风暴前一周，与上一年相比，来自熟练护理设施（SNF）的医院转院增加了39%，住院患者出院的平均住院时间减少了0.3天。在风暴后一周，全州范围内的急诊科就诊增加了14%；在这些额外的“激增”患者中，20%被收治入院。在受影响最严重的沿海地区，急诊科需求的增加超过全州平均水平的两倍（35%对14%）。
超级风暴桑迪影响了新泽西州风暴前后的患者流动；登陆后急诊科就诊量激增与整体风暴影响相关，沿海县受影响最大。风暴前转院患者的数量和严重程度显著增加，尤其是来自熟练护理设施的患者，以及风暴后急诊科就诊和住院收治情况的增加，凸显了在大规模事件中采用协作性区域医疗方法的重要性。
