Building a National Standard for Outreach and Assistance to At-Risk Patients During Large-Scale Disasters.

Health care institutions play an essential role in community resilience. As one of the largest health care systems in the United States, the Veterans Health Administration (VHA) plays a critical role in supporting medically vulnerable Veterans during disasters. Disasters require large-scale outreach to individuals in affected areas, including the capability to identify patients, establish contact, determine needs, and deliver required services. Here we describe the development and implementation of VHA's Vulnerable Patient Care, Access, and Response in Emergencies (VP CARE) program, a data-driven system of outreach to preidentified medically vulnerable patients, which seeks to streamline this process. VP CARE was inspired by the VHA's Home-Based Primary Care (HBPC) program and the US Department of Health and Human Services' emPOWER program. It seeks to enhance Veteran patients' well-being and continuity of care during disasters using 3 components: (1) improving the readiness and resilience of vulnerable patients and their caregivers; (2) establishing an organization, policies, procedures, and competency-based training exercises to guide outreach and assistance; and (3) creating and implementing standardized 1- and 2-way outreach technology and reporting. Using Geographic Information Systems embedded in VP CARE, VHA can generate a list of high-risk patients and deploy a 2-way texting capability to contact and receive responses from them. VP CARE automatically tracks patient contact and responses, reducing duplication of effort and freeing up VA staff to focus on patients with immediate needs. Patients and their caregivers benefit from the reassurance of knowing that VHA is focused on their well-being and available to support them. The technologies deployed in VP CARE improve the efficiency of outreach efforts and reduce the risk of life-threatening harm, while reducing the cost and demands on VA staff. This article concludes with lessons learned that may be instructive for other health care systems seeking to establish similar outreach capabilities.

Assessing Hospital Disaster Readiness Over Time at the US Department of Veterans Affairs.

Introduction There have been numerous initiatives by government and private organizations to help hospitals become better prepared for major disasters and public health emergencies. This study reports on efforts by the US Department of Veterans Affairs (VA), Veterans Health Administration, Office of Emergency Management's (OEM) Comprehensive Emergency Management Program (CEMP) to assess the readiness of VA Medical Centers (VAMCs) across the nation. Hypothesis/Problem This study conducts descriptive analyses of preparedness assessments of VAMCs and examines change in hospital readiness over time. METHODS: To assess change, quantitative analyses of data from two phases of preparedness assessments (Phase I: 2008-2010; Phase II: 2011-2013) at 137 VAMCs were conducted using 61 unique capabilities assessed during the two phases. The initial five-point Likert-like scale used to rate each capability was collapsed into a dichotomous variable: "not-developed=0" versus "developed=1." To describe changes in preparedness over time, four new categories were created from the Phase I and Phase II dichotomous variables: (1) rated developed in both phases; (2) rated not-developed in Phase I but rated developed in Phase II; (3) rated not-developed in both phases; and (4) rated developed in Phase I but rated not- developed in Phase II. RESULTS: From a total of 61 unique emergency preparedness capabilities, 33 items achieved the desired outcome - they were rated either "developed in both phases" or "became developed" in Phase II for at least 80% of VAMCs. For 14 items, 70%-80% of VAMCs achieved the desired outcome. The remaining 14 items were identified as "low-performing" capabilities, defined as less than 70% of VAMCs achieved the desired outcome. CONCLUSION: Measuring emergency management capabilities is a necessary first step to improving those capabilities. Furthermore, assessing hospital readiness over time and creating robust hospital readiness assessment tools can help hospitals make informed decisions regarding allocation of resources to ensure patient safety, provide timely access to high-quality patient care, and identify best practices in emergency management during and after disasters. Moreover, with some minor modifications, this comprehensive, all-hazards-based, hospital preparedness assessment tool could be adapted for use beyond the VA. Der-Martirosian C , Radcliff TA , Gable AR , Riopelle D , Hagigi FA , Brewster P , Dobalian A . Assessing hospital disaster readiness over time at the US Department of Veterans Affairs. Prehsop Disaster Med. 2017;32(1):46-57.

Developing Valid Measures of Emergency Management Capabilities within US Department of Veterans Affairs Hospitals.

UNLABELLED: Introduction Hospitals play a critical role in providing health care in the aftermath of disasters and emergencies. Nonetheless, while multiple tools exist to assess hospital disaster preparedness, existing instruments have not been tested adequately for validity. Hypothesis/Problem This study reports on the development of a preparedness assessment tool for hospitals that are part of the US Department of Veterans Affairs (VA; Washington, DC USA). METHODS: The authors evaluated hospital preparedness in six "Mission Areas" (MAs: Program Management; Incident Management; Safety and Security; Resiliency and Continuity; Medical Surge; and Support to External Requirements), each composed of various observable hospital preparedness capabilities, among 140 VA Medical Centers (VAMCs). This paper reports on two successive assessments (Phase I and Phase II) to assess the MAs' construct validity, or the degree to which component capabilities relate to one another to represent the associated domain successfully. This report describes a two-stage confirmatory factor analysis (CFA) of candidate items for a comprehensive survey implemented to assess emergency preparedness in a hospital setting. RESULTS: The individual CFAs by MA received acceptable fit statistics with some exceptions. Some individual items did not have adequate factor loadings within their hypothesized factor (or MA) and were dropped from the analyses in order to obtain acceptable fit statistics. The Phase II modified tool was better able to assess the pre-determined MAs. For each MA, except for Resiliency and Continuity (MA 4), the CFA confirmed one latent variable. In Phase I, two sub-scales (seven and nine items in each respective sub-scale) and in Phase II, three sub-scales (eight, four, and eight items in each respective sub-scale) were confirmed for MA 4. The MA 4 capabilities comprise multiple sub-domains, and future assessment protocols should consider re-classifying MA 4 into three distinct MAs. CONCLUSION: The assessments provide a comprehensive and consistent, but flexible, approach for ascertaining health system preparedness. This approach can provide an organization with a clear understanding of areas for improvement and could be adapted into a standard for hospital readiness. Dobalian A , Stein JA , Radcliff TA , Riopelle D , Brewster P , Hagigi F , Der-Martirosian C . Developing valid measures of emergency management capabilities within US Department of Veterans Affairs hospitals. Prehosp Disaster Med. 2016;31(5):475-484.

Using exercises to identify Veterans Health Administration priorities for disaster response: findings from the New Madrid Earthquake training exercise.

Emergency managers are often charged with prioritizing the relative importance of key issues and tasks associated with disaster response. However, little work has been done to identify specific ways that the decision-making process can be improved. This exercise was conducted with 220 employees of the US Department of Veterans Affairs, who were asked to assign priority rankings to a list of possible options of the most important issues to address after a hypothetical disaster scenario impacting a Veterans Affairs Medical Center. We found that groups that were assigned to represent perspectives farther from the impacted site had less agreement in their identification of the top priorities than those assigned to the impacted facility. These findings suggest that greater geographic and administrative proximity to the impacted site may generate greater clarity and certainty about priority setting. Given the complex structure of many organizations, and the multiple levels of group decision making and coordination likely to be needed during disasters, research to better understand training needs with respect to decision making is essential to improve preparedness. Relatively simple modifications to exercises, as outlined here, could provide valuable information to better understand emergency management decision making across multiple organizational levels.