- As communities across the country are hit with natural disasters, healthcare organizations must create contingency plans to help preserve patient access to care during disaster recovery.
According to new research published in the Journal of the American Board of Family Medicine, these precautions need to include measures of ambulatory care utilization and recovery of cancelled appointments during and following natural disasters. The study, published in the March and April edition of the journal, highlighted a key strategy for measuring those factors.
There are currently limited best practices for preserving patient access to ambulatory care during a natural disaster. When a major storm occurs, ambulatory clinics may cancel appointments with patients. It is essential that organizations create continuity of care for patients managing chronic illness lest their conditions worsen.
“Scheduled ambulatory care remains the most-used type of care in the United States,” the researchers explained. “Because disasters may jeopardize care continuity if patients evacuate or need to seek care outside of their planned encounter, disaster-related care disruptions may result in exacerbated chronic conditions or limit preventive care and lead to more expensive emergency department or hospital-based care.”
Most healthcare organizations have the ability to quickly notify patients when care will be disrupted due to storm. Medical facilities are also usually able to direct patients to alternative resources. The next step to those precautions is predicting how the practice will be able to reschedule canceled appointments, the researchers said.
“While the majority of practices reported having a plan, clinics may not have time or resources available when disasters occur to actively prioritize rescheduling missed appointments,” the team pointed out. “This study offers practical metrics to measure near real-time ambulatory care recovery and resiliency around emergency events using appointment disposition data to calculate measures for comparison across clinics and locations, and over time.”
The researchers tested the measure strategy in a Veterans Affairs (VA) health system in the Gulf Coast region. Each studied clinic served patients who had been affected by a category four hurricane. The clinics were categorized as primary care, mental health care, specialty care, other health professionals such as dental or optometry, and telehealth.
The researchers investigated two factors – ambulatory care recovery and resiliency. Recovery translated to the median business days needed to recover canceled appointments. Ambulatory care resiliency was the change in percentage of appointment completion before, during, and after a disaster.
The researchers found that for both measures, clinics closely located to the storm’s epicenter were more adversely affected. These clinics took longer to recover the appointments they canceled due to the storm, and completed fewer appointments around the time of the storm.
Ambulatory care resiliency specifically took a hard hit closer to the storm location, the researchers reported. Clinics far away from the storm’s center saw resiliency rates essentially unchanged, but those closer to the storm saw rates increase by more than 10 percent.
“Most clinics in affected areas achieved appointment completion percentages that matched or exceeded pre-storm levels within 2 weeks of the storm,” the researchers reported. “By contrast, the appointment completion percentages for clinics in locations not affected by the storm remained stable over time, suggesting the resiliency metric captures both the event and the relative severity of the event.”
The study’s fundamental takeaway is not necessarily the frequency at which this unique health system could recover or maintain patient care access during a natural disaster. Instead, the study highlights an approach that other health systems can replicate to quantify their own abilities to manage patient healthcare access.
“This article presents a simple, flexible, and feasible approach to quantify ambulatory care recovery and resiliency before, during, and after disasters and presents an illustration of the metrics applied to a major disaster for one health care system that provides primary care to vulnerable patients with significant health care needs and with historic barriers to accessing care in other health systems,” the researchers pointed out.
“While conceptually and mathematically straightforward, these types of calculations support information needs for providers and population health that are increasingly important as disasters become both more frequent and more severe,” the team added.
Health systems should integrate these measures routinely into their disaster recovery plans, the researchers asserted. This is a first step in creating disaster recovery plans.
Some healthcare organizations have created disaster recovery plans related to health data security and data infrastructure. Another missing piece of the puzzle is figuring out how chronically ill patients are going to access care when there is a natural disaster. These results are the starting point for medical professionals putting into place contingency plans for patient care access.
Healthcare professionals should also consider patient health data access, data exchange, and the breadth of health systems in further studies, the researchers said.
“Future work should examine whether recent trends in practice affiliation systems and the ‘franchising’ of primary care clinics has reduced disaster-related care disruptions,” the team said. “More family practice providers may have linked medical records, shared resources, and integrated scheduling systems that are similar to the integration found in VA records. “
From there, organizations can create their own unique disaster recovery strategies. Each patient population will need different care plans depending upon both their health needs and the region’s weather risks.
“Quantifying care disruption is an important step in being able to assess the effectiveness of interventions after future disasters, for example, deploying labor from outside the community to temporarily supplement routine care needs that were disrupted by the storm,” the team concluded. “Accordingly, the use of standardized metrics such as this could improve recovery and resiliency for providers and the communities they serve.”