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BACKGROUND/RATIONALE:
This exploratory/pilot project will evaluate the evacuation of veterans from nursing homes in areas affected by Hurricanes Katrina and Rita. The evacuation of New Orleans and surrounding areas following Hurricane Katrina was the largest non-military evacuation of civilians in the United States. The healthcare systems in many of these areas were also further affected by a secondary event, Hurricane Rita. Existing research within and outside VA does not adequately address health issues for frail and/or mentally ill elders during evacuations, and this is particularly true within nursing homes. Limited research on evacuation exists in other settings (e.g., hospitals). The devastating scope of these disasters provides an opportunity to better understand the health needs of residents during and after evacuation, and examine a range of system, coordination, and integration issues related to the delivery of high-quality services for these vulnerable populations.
OBJECTIVE(S):
(1) To understand the processes related to variations in evacuation and effective disaster-response in VA nursing homes following Hurricanes Katrina and Rita. (2) To understand the impact of the evacuations on the quality of care for veterans who were residents in these facilities.
METHODS:
This study builds on two complementary conceptual models. The organizational-level model for objective 1 posits that certain organizational characteristics of the facility (e.g., type and size of home; leadership), disaster (e.g., magnitude and severity; advance warning), and environment (e.g., availability and competing demand for emergency services that are assumed to be available and integral to the disaster plan), and the extent of disaster plans and preparedness influence a home’s evacuation processes and outcomes. The patient-level model for quality of care (objective 2) uses a structure-process-outcomes approach. As past outcomes assessment studies have not consistently demonstrated a correlation between processes and outcomes of care, our model will also include patient and environmental risk factors that were often excluded in prior studies. Data will be collected via semi-structured key informant interviews with organizational representatives (healthcare providers, administrators, and policymakers) from VA. We will use computer software, ATLAS.ti, designed specifically for narrative interview and/or field notes, to synthesize the qualitative data. This process will involve independently reviewing a subset of the interview transcripts, assigning content themes, reviewing the independently derived themes and determining which will be used to form the initial set of codes. Following the development of the initial coding schemes, these codes will be applied to another subset of the interviews. As this step is accomplished, new themes and sub-themes are likely to emerge, and emerging themes and sub-themes will be reviewed and revised as appropriate.
FINDINGS/RESULTS:
This is an ongoing project and results have not yet been obtained.
IMPACT:
The overwhelming scale of these disasters provides a unique opportunity to comprehensively examine the VA’s ability to respond to system-wide challenges and ensure access to high-quality services. This understanding will provide information to reinforce effective strategies while improving VA’s public health emergency preparedness for future disasters. Findings from this study will help VA administrators and healthcare providers understand considerations that differentiate frail elders from others after natural disasters.
PUBLICATIONS:
None at this time.
DRA:
none
DRE:
none
Keywords:
none
MeSH Terms:
none
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