Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-05T09:36:13.619Z Has data issue: false hasContentIssue false
  • English
  • Français

Redistribution of Emergency Department Patients After Disaster-Related Closures of a Public Versus Private Hospital in New York City

Published online by Cambridge University Press:  17 March 2015

David C. Lee ,
Silas W. Smith ,
Brendan G. Carr ,
Lewis R. Goldfrank  and
Daniel Polsky
David C. Lee*
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine Department of Population Health, New York University School of Medicine, and RWJF Clinical Scholars Program, University of Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania
Silas W. Smith
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine
Brendan G. Carr
Affiliation:
Department of Emergency Medicine, Kimmel School of Medicine, Thomas Jefferson University, and Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness & Response, Department of Health & Human Services
Lewis R. Goldfrank
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine
Daniel Polsky
Affiliation:
Leonard Davis Institute of Health Economics, University of Pennsylvania Department of Health Care Management, The Wharton School, University of Pennsylvania, and Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania.
*
Correspondence and reprint requests to David C. Lee, Departments of Emergency Medicine and Population Health, NYU School of Medicine, 462 First Avenue, Room A345, New York, NY 10016 (e-mail: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Sudden hospital closures displace patients from usual sources of care and force them to access facilities that lack their prior medical records. For patients with complex needs and for nearby hospitals already strained by high volume, disaster-related hospital closures induce a public health emergency. Our objective was to analyze responses of patients from public versus private emergency departments after closure of their usual hospital after Hurricane Sandy. Using a statewide database of emergency visits, we followed patients with an established pattern of accessing 1 of 2 hospitals that closed after Hurricane Sandy: Bellevue Hospital Center and NYU Langone Medical Center. We determined how these patients redistributed for emergency care after the storm. We found that proximity strongly predicted patient redistribution to nearby open hospitals. However, for patients from the closed public hospital, this redistribution was also influenced by hospital ownership, because patients redistributed to other public hospitals at rates higher than expected by proximity alone. This differential response to hospital closures demonstrates significant differences in how public and private patients respond to changes in health care access during disasters. Public health response must consider these differences to meet the needs of all patients affected by disasters and other public health emergencies. (Disaster Med Public Health Preparedness. 2015;9:256-264).

Keywords

hurricanedisaster medicinepublic healthemergency medicinesurge capacity
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 9 , Issue 3 , June 2015 , pp. 256 - 264
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hsia, RY, Srebotnjak, T, Kanzaria, HK, et al. System-level health disparities in California emergency departments: minorities and Medicaid patients are at higher risk of losing their emergency departments. Ann Emerg Med. 2012;59(5):358-365.Google Scholar
2. Ko, M, Needleman, J, Derose, KP, et al. Residential segregation and the survival of U.S. urban public hospitals. Med Care Res Rev. 2014;71(3):243-260.CrossRefGoogle ScholarPubMed
3. Greenough, PG, Lappi, MD, Hsu, EB, et al. Burden of disease and health status among Hurricane Katrina-displaced persons in shelters: a population-based cluster sample. Ann Emerg Med. 2008;51(4):426-432.Google Scholar
4. Sun, BC, Mohanty, SA, Weiss, R, et al.. Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004. Ann Emerg Med. 2006;47(4):309-316.Google Scholar
5. Powell, T, Hanfling, D, Gostin, LO. Emergency preparedness and public health: the lessons of Hurricane Sandy. JAMA. 2012;308(24):2569-2570.Google Scholar
6. Uppal, A, Evans, L, Chitkara, N, et al. In search of the silver lining: the impact of Superstorm Sandy on Bellevue Hospital. Ann Am Thorac Soc. 2013;10(2):135-142.CrossRefGoogle Scholar
7. Lee, DC, Smith, SW, McStay, CM, et al. Rebuilding emergency care after Hurricane Sandy. Disaster Med Public Health Prep. 2014;8(2):119-122.Google Scholar
8. Subaiya, S, Moussavi, C, Velasquez, A, et al. A rapid needs assessment of the Rockaway Peninsula in New York City after Hurricane Sandy and the relationship of socioeconomic status to recovery. Am J Public Health. 2014;104(4):632-638.Google Scholar
9. Adalja, AA, Watson, M, Bouri, N, et al. Absorbing citywide patient surge during Hurricane Sandy: a case study in accommodating multiple hospital evacuations. Ann Emerg Med. 2014;64(1):66-73.e61.Google Scholar
10. McLafferty, S. Neighborhood characteristics and hospital closures. A comparison of the public private and voluntary hospital systems. Soc Sci Med. 1982;16(19):1667-1674.CrossRefGoogle ScholarPubMed
11. Quan, JM. SPARCS: the New York State health care data system. J Clin Comput. 1980;8(6):255-263.Google Scholar
12. Congdon, P. The development of gravity models for hospital patient flows under system change: a Bayesian modelling approach. Health Care Manag Sci. 2001;4(4):289-304.Google Scholar
13. Sarrazin, MS, Campbell, ME, Richardson, KK, et al. Racial segregation and disparities in health care delivery: conceptual model and empirical assessment. Health Serv Res. 2009;44(4):1424-1444.Google Scholar
14. Wharam, JF, Zhang, F, Landon, BE, et al. Low-socioeconomic-status enrollees in high-deductible plans reduced high-severity emergency care. Health Aff (Millwood). 2013;32(8):1398-1406.Google Scholar
15. Rudowitz, R, Rowland, D, Shartzer, A. Health care in New Orleans before and after Hurricane Katrina. Health Aff (Millwood). 2006;25(5):w393-w406.CrossRefGoogle ScholarPubMed
16. Levin, KL, Berliner, M, Merdjanoff, A. Disaster planning for vulnerable populations: leveraging Community Human Service Organizations direct service delivery personnel. J Public Health Manag Pract. 2014;20(Suppl 5):S79-S82.Google Scholar
17. Kennedy, L, Dumas, MB. Hospital closures and survivals: an analysis of operating characteristics and regulatory mechanisms in three states. Health Serv Res. 1983;18(4):489-512.Google Scholar
18. Whiteis, DG. Hospital and community characteristics in closures of urban hospitals, 1980-87. Public Health Rep. 1992;107(4):409-416.Google Scholar
19. Cleverly, WO. More efficient hospitals are closing. Healthc Financ Manage. 1993;47(4):82, 84-85.Google Scholar
20. Landry, AY, Landry, RJ 3rd. Factors associated with hospital bankruptcies: a political and economic framework. J Healthc Manag. 2009;54(4):252-271; discussion 271-252.Google ScholarPubMed
21. Institute of Medicine Committee on the Future of Emergency Care in the U.S. Health Care System. Hospital Based Emergency Care: At the Breaking Point. Washington, DC: National Academy Press; 2006.Google Scholar
22. US Department of Health & Human Services. Public Health Emergency website. Immediate Bed Availability. http://www.phe.gov/coi/Pages/iba.aspx. Accessed October 7, 2014.Google Scholar
23. Liu, C, Srebotnjak, T, Hsia, RY. California emergency department closures are associated with increased inpatient mortality at nearby hospitals. Health Aff (Millwood). 2014;33(8):1323-1329.Google Scholar
24. Hsia, RY, Shen, YC. Rising closures of hospital trauma centers disproportionately burden vulnerable populations. Health Aff (Millwood). 2011;30(10):1912-1920.CrossRefGoogle ScholarPubMed
25. Post, DE, Kasofsky, JM, Hunte, CN, et al. A regional human services authority’s rapid needs assessment of evacuees following natural disasters. Am J Disaster Med. 2008;3(5):253-264.Google ScholarPubMed
26. Sheppa, CM, Stevens, J, Philbrick, JT, et al. The effect of a class IV hurricane on emergency department operations. Am J Emerg Med. 1993;11(5):464-467.CrossRefGoogle ScholarPubMed
27. Smith, CM, Graffeo, CS. Regional impact of Hurricane Isabel on emergency departments in coastal southeastern Virginia. Acad Emerg Med. 2005;12(12):1201-1205.Google Scholar
28. Teperman, S. Hurricane Sandy and the greater New York health care system. J Trauma Acute Care Surg. 2013;74(6):1401-1410.Google Scholar
29. Buchmueller, TC, Jacobson, M, Wold, C. How far to the hospital? The effect of hospital closures on access to care. J Health Econ. 2006;25(4):740-761.Google Scholar
30. Committee on Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Washington, DC: National Academies Press, Institute of Medicine; 2012.Google Scholar
31. Redlener, I, Reilly, MJ. Lessons from Sandy--preparing health systems for future disasters. N Engl J Med. 2012;367(24):2269-2271.Google Scholar
32. Lee, JE, Sung, JH, Ward, WB, et al. Utilization of the emergency room: impact of geographic distance. Geospat Health. 2007;1(2):243-253.Google Scholar
33. Henneman, PL, Garb, JL, Capraro, GA, et al. Geography and travel distance impact emergency department visits. J Emerg Med. 2011;40(3):333-339.CrossRefGoogle ScholarPubMed
34. McLafferty, S. Predicting the effect of hospital closure on hospital utilization patterns. Soc Sci Med. 1988;27(3):255-262.Google Scholar
35. Rudge, GM, Mohammed, MA, Fillingham, SC, et al. The combined influence of distance and neighbourhood deprivation on Emergency Department attendance in a large English population: a retrospective database study. PLoS One. 2013;8(7):e67943.Google Scholar
36. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency website. Hospital Preparedness Program. 07/16/2014. http://www.phe.gov/PREPAREDNESS/PLANNING/HPP/Pages/default.aspx. Accessed October 7th, 2014.Google Scholar
37. Blair, R. Disaster-proof patients. Health Manag Technol. 2007;28(2):44, 46-47.Google Scholar
38. Newman, DM. EHRs and disaster management. Fam Pract Manag. 2006;13(1):20.Google Scholar
39. Lien, C, Raimo, J, Abramowitz, J, et al. Community healthcare delivery post-Hurricane Sandy: lessons from a mobile health unit. J Community Health. 2014;39(3):599-605.Google Scholar
40. Myers, SR, Branas, CC, Kallan, MJ, et al. The use of home location to proxy injury location and implications for regionalized trauma system planning. J Trauma. 2011;71(5):1428-1434.Google Scholar