Lukowsky Lilia R, Dobalian Aram, Goldfarb David S, Kalantar-Zadeh Kamyar, Der-Martirosian Claudia
1 Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA.
2 University of Memphis School of Public Health, Memphis, TN, USA.
J Prim Care Community Health. 2019 Jan-Dec;10:2150132719863599. doi: 10.1177/2150132719863599.
This study examines the use of dialysis services by end-stage renal disease (ESRD) patients following the Superstorm Sandy-related, months-long closure of the New York campus of the US Department of Veterans Affairs (VA) New York Harbor VA Healthcare System (NYHHS, Manhattan VAMC). Outpatient visits, dialysis care, emergency department visits, and hospitalizations at VA and non-VA facilities for 47 Manhattan VAMC ESRD patients were examined 12 months pre- and post-Sandy using VA administrative and clinical data. The Brooklyn campus of NYHHS, which is within ten miles of Manhattan VAMC, experienced the largest increase in the number of dialysis encounters after the closure. Dialysis encounters for VA patients also increased at non-VA facilities, rising on average, to 106 per month. For the James J Peters Bronx VAMC, the number of total dialysis encounters for Manhattan VAMC patients fluctuated between 39 and 43 per month, dropping to less than 30 after the Manhattan VAMC dialysis unit reopened. Manhattan VAMC ESRD patients used nearby alternate VA sites and non-VA clinics for their care during the closure of the Manhattan VAMC dialysis unit. The VA electronic health records played an important role in ensuring continuity of care for patients who exclusively used VAMC facilities post-Sandy because patient information was immediately accessible at other VA facilities. The events related to Superstorm Sandy highlight the need for dialysis providers to have a comprehensive disaster plan, including nearby alternate care sites that can increase service capacity when a dialysis facility is closed because of a disaster.
本研究调查了美国退伍军人事务部（VA）纽约港VA医疗系统（NYHHS，曼哈顿退伍军人医疗中心）纽约校区因超级风暴桑迪关闭长达数月后，终末期肾病（ESRD）患者对透析服务的使用情况。利用VA的行政和临床数据，对47名曼哈顿退伍军人医疗中心的ESRD患者在桑迪前后12个月内在VA和非VA设施的门诊就诊、透析护理、急诊就诊及住院情况进行了调查。NYHHS的布鲁克林校区距离曼哈顿退伍军人医疗中心不到10英里，在关闭后透析诊疗次数增加最多。VA患者在非VA设施的透析诊疗次数也有所增加，平均每月增至106次。对于詹姆斯·J·彼得斯布朗克斯退伍军人医疗中心，曼哈顿退伍军人医疗中心患者的透析诊疗总次数每月在39至43次之间波动，在曼哈顿退伍军人医疗中心透析单元重新开放后降至不到30次。在曼哈顿退伍军人医疗中心透析单元关闭期间，曼哈顿退伍军人医疗中心的ESRD患者利用附近的其他VA站点和非VA诊所进行治疗。VA电子健康记录在确保桑迪后专门使用退伍军人医疗中心设施的患者的护理连续性方面发挥了重要作用，因为患者信息在其他VA设施可立即获取。与超级风暴桑迪相关的事件凸显了透析服务提供者制定全面灾难计划的必要性，包括附近的备用护理站点，以便在透析设施因灾难关闭时能够增加服务能力。
