Health Services Research & Development

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Radcliff TA, Chu K, Der-Martirosian C, Dobalian A. A Model for Measuring Ambulatory Access to Care Recovery after Disasters. Journal of the American Board of Family Medicine : JABFM. 2018 Mar 1; 31(2):252-259.
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Abstract: INTRODUCTION: Although little research has examined impacts of disasters on scheduled ambulatory care services, routine care delivery is important for emergency planning and response because missed or delayed care can lead to more urgent care needs. This article presents potential measures of ambulatory care recovery and resilience and applies the measures to data around a recent disaster. METHODS: We conceptualize "ambulatory care recovery" as the change in median business days to complete appointments that were canceled, and "ambulatory care resiliency" as the change in percentage of completed appointments in time frames before, during, and after disasters. Appointments data from Veterans Affairs (VA) clinics were examined around a category 4 hurricane that affected a coastal area with a substantial veteran population. RESULTS: For the disaster studied, ambulatory care resilience was associated with geographic proximity to the storm's impact. Primary care recovery was longer in locations closest to storm landfall. This research indicates the usefulness of routine appointments data in emergency planning. CONCLUSION: Quantifying care disruptions around disasters is an important step in assessing interventions to improve emergency preparedness and response for clinics. The illustrative example of measures captured the disaster event duration and severity in relation to ambulatory care appointments.