Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances ( i.e., technological disasters) to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.
References
[1]
Aronoff, M.; Gunter, V. Defining disaster: Local constructions for recovery in the aftermath of chemical contamination. Soc. Probl. 1992, 39, 345–365, doi:10.2307/3097015.
[2]
Baum, A.; Fleming, I. Implications of psychological research on stress and technological accidents. Am. Psychol. 1993, 48, 665–672, doi:10.1037/0003-066X.48.6.665.
[3]
Edwards, M.L.K. An interdisciplinary perspective on disasters and stress: The promise of an ecological framework. Sociol. Forum 1998, 13, 115–132, doi:10.1023/A:1022112132247.
[4]
Hospital Staffing and Surge Capacity during a Disaster Event. Available online: http://www.naph.org/Main-Menu-Category/Publications/Emergency-Preparedness/hospitalstaffingandsurgecapacityduringadisasterevent.aspx?FT=.pdf (accessed on 11 November 2011).
[5]
DeLia, D.; Wood, E. The dwindling supply of empty beds: Implications for. hospital surge capacity. Health Affairs 2008, 27, 1688–1694, doi:10.1377/hlthaff.27.6.1688.
Altevogt, B.M.; Pope, A.M.; Hill, M.N.; Shine, K.I. Reference. In Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report; The National Academies Press: Washington, DC, USA, 2008.
[8]
Handler, J.A.; Gillam, M.; Kirsch, T.D.; Feied, C.F. Metrics in the science of surge. Acad. Emerg. Med. 2006, 13, 1173–1178, doi:10.1111/j.1553-2712.2006.tb01644.x.
[9]
WHO. The New Emergency Health Kit: Emergency Supplies for 10,000 Persons for 30 Days; Report Number: 10.000 (1st Edition). World Health Organization: Geneva, Switzerland, 1990.
[10]
Chmatal, P.; Bohonek, M.; Dobiasova, M.; Hasek, R.; Cernohous, M. A humanitarian mission in southern Iraq: Utlization of the 7th Field Hospital of the Army of the Czech Republic: A report on its medical activities and working conditions. Milit. Med. 2005, 170, 473–476.
[11]
Sharp, T.W.; Yip, R.; Malong, J.S. U.S. military forces and emergency international humanitarian assistance: Observations and recommendations from three recent missions. J. Amer. Med. Assn. 1994, 272, 386–390, doi:10.1001/jama.1994.03520050066032.
[12]
Weddle, M.; Prado-Monje, H. The use of deployable military hospitals after hurricanes: Lessons from the Hurricane Marilyn response. Milit. Med. 2000, 154, 411–417.
[13]
D’Amore, A.R.; Hardin, C.K. Air Force expedititionary medical support unit at the Houston floods: Use of military model in civilian disaster response. Milit. Med. 2005, 170, 103–106.
[14]
Centers for Disease Control and Prevention. Update on CDC’s Response to Hurricane Katrina. Available online: http://www.cdc.gov/od/katrina/ (accessed on 12 March 2011).
[15]
Survey of Hurricane Katrina Evacuees. Available online: http://www.kff.org/newsmedia/7401.cfm (accessed on 21 October 2011).
[16]
Ford, E.S.; Mokdad, A.H.; Link, M.W.; Garvin, W.S.; McGuire, L.C.; Jiles, R.B.; Balluz, L.S. Chronic disease in health emergencies: In the eye of the hurricane. Prev. Chron. Dis. Public Health Res. Pract. Policy 2006, 3, 1–7.
[17]
Krol, D.M.; Redlener, M.; Shapiro, A.; Wajnberg, A. A mobile medical care approach targeting underserved populations in post-Hurricane Katrina Mississippi. J. Health Care Poor Underserve 2007, 18, 331–340, doi:10.1353/hpu.2007.0038.
[18]
Mokdad, A.H.; Mensah, G.A.; Posner, S.F.; Reed, E.; Simoes, E.J.; Engelgau, M.M. When Chronic Conditions Become Acute: Prevention and Control of Chronic Diseases and Adverse Health Outcomes during Natural Disasters. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1459465/ (accessed on 19 December 2011).
[19]
Axelrod, C.; Killam, P.P.; Gaston, M.H.; Stinson, N. Primary health care and the midwest flood disaster. Public Health Rep. 1994, 109, 601–605.
[20]
Bayard, D. Haiti earthquake relief, phase two—Long-term needs and local resources. N. Engl. J. Med. 2010, 362, 1858–1861, doi:10.1056/NEJMp1003839.
[21]
Brodie, M.; Weltzien, E.; Altman, D.; Blendon, R.J.; Benson, J.M. Experiences of hurricane Katrina evacuees in Houston shelters: Implications for future planning. Am. J. Public Health 2006, 96, 1402–1408, doi:10.2105/AJPH.2005.084475.
[22]
Dorn, T.; Yzermans, C.J.; Kerseens, J.J.; Spreeuwenberg, P.M.; van der Zee, J. Disaster and subsequent healthcare utilization: A longitudinal study among victims, their family members, and control subjects. Med. Care 2006, 44, 581–589, doi:10.1097/01.mlr.0000215924.21326.37.
[23]
Medically Underserved Areas and Populations (MUA/Ps): Guidelines for MUA and MUP Designation. Shortage Designations 2011. Available online: http://bhpr.hrsa.gov/shortage/muaps/index.html. (accessed on 12 June 2011).
[24]
Burkle, F.M., Jr. Mass casualty management of a large-scale bioterrorist event: An epidemiological approach that shapes triage decisions. Emerg. Med. Clin. North Am. 2002, 20, 409–436, doi:10.1016/S0733-8627(01)00008-6.
[25]
Noji, E.K. The public health consequences of disasters. Prehosp. Disaster Med. 2000, 15, 147–157.
[26]
Wetterhall, S.F.; Noji, E.K. Surveillance and Epidemiology. In Public Health Consequences of Disasters; Oxford University Press: New York, NY, USA, 1997; pp. 37–64.
[27]
Billings, J.; Parikh, N.; Miljanovich, T. Emergency Room Use: The New York Story. Available online: http://www.commonwealthfund.org/usr_doc/billings_nystory.pdf (accessed on 7 May 2011).
[28]
Billings, J.; Zeitel, L.; Lukomnik, J.; Carey, T.S.; Blank, A.E.; Newman, L. Impact of socioeconomic status on hospital use in New York City. Health Aff. 1993, 12, 162–173.
[29]
Agency for Healthand Quality, AHRQ Quality Indicators—Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. Available online: www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V31?pqi_guide_v31.pdf (accessed on 29 October 2011).
[30]
Ansari, Z.; Laditka, J.N.; Laditka, S.B. Access to health care and hospitalization for ambulatory care sensitive conditions. Med. Care Res. Rev. 2006, 63, 719–741, doi:10.1177/1077558706293637.
[31]
Caminal, J.; Caminal, J.; Starfield, B.; Sanchez, E.; Casanova, C.; Morales, M. The role of primary care in preventing ambulatory care sensitive conditions. Eur. J. Public Health 2004, 14, 246–251, doi:10.1093/eurpub/14.3.246.
[32]
Falik, M.; Needleman, J.; Wells, B.L.; Korb, J. Ambulatory care sensitive hospitalizations and emergency visits: Experiences of medicaid patients using federally qualified health centers. Med. Care 2001, 39, 551–561, doi:10.1097/00005650-200106000-00004.
[33]
Cook, T.D.; Campbell, D.T. Reference. In Quasi-Experimentation Design and Analysis Issues for Field Settings; Houghton Mifflin Company: Boston, MA, USA, 1979.
[34]
Box, G.E.P.; Jenkins, G.M.; Reinesl, G.C. Reference. In Time Series Analysis: Forecasting and Control; Prentice Hall: Upper Saddle River, NJ, USA, 1994.
[35]
Dickey, D.A.; Fuller, W.A. Distribution of the estimators for autoregressive time series with a unit root. J. Amer. Stat. Assn. 1979, 74, 427–431.
[36]
Brocklebank, J.C.; Dickey, D.A. Chapter 7: The ARIMA Procedure. In SAS System for Forecasting Time Series, 2nd ed.; SAS Institute Inc.: Cary, NC, USA, 2003; pp. 323–358.
[37]
Svendsen, E.R.; Whittle, N.C.; Sanders, L.; McKeown, R.E.; Sprayberry, K.; Heim, M.; Caldwell, R.; Gibson, J.J.; Vena, J. GRACE: Public health recovery methods following an environmental disaster. Arch. Environ. Occup. Health 2010, 65, 77–85, doi:10.1080/19338240903390222.
[38]
Ginsberg, J.P.; Holbrook, J.R.; Chanda, D.; Bao, H.; Svendsen, E.R. Posttraumatic stress and tendency to panic in the aftermath of the chlorine gas disaster in Graniteville, South. Carolina. Soc. Psychiatr. Epidemiol. 2012, 47, 1441–1448, doi:10.1007/s00127-011-0449-6.
[39]
Epstein, A.J. The role of public clinics in preventable hospitalizations among vulnerable populations. Health Serv. Res. 2001, 26, 405–420.
