Healthy, Resilient, and Sustainable Communities After Disasters Strategies, Opportunities, and Planning for Recovery (2015) / Chapter Skim
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6 Health Care
6 Health Care
Pages 193-242
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From page 193... ...
In the early recovery period, health care recovery planning should be initiated with assessment of residual health care sector capacities and challenges and, for long-term planning, acknowledgment of current and planned changes in health care delivery and financing systems. For example, as of the writing of this report, planning for long-term community health needs might include consideration of possible expanded access to preventive services stemming from the Patient Protection and Affordable Care Act1 (ACA)
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From page 194... ...
HEALTH CARE IN THE CONTEXT OF A HEALTHY COMMUNITY The degree of integration of health care services with each other and across the continuum of public health, behavioral health, and social services contributes significantly to overall community health and, relatedly, the community's resilience to withstand the impacts of a disaster. This comprehensive and integrated vision of health has been incorporated into major influential initiatives that continuously assess the health of the nation, including America's Health Rankings, the Commonwealth Fund's Scorecard, and the Robert Wood Johnson Foundation's County Health Rankings (County Health Rankings, 2014; Radley et al., 2014; United Health Foundation, 2013)
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From page 195... ...
It also provides incentives for developing collaborative relationships among local care delivery organizations, which are key to building resilience. Two related efforts provide guidance and opportunities relevant to the ongoing task of strengthening and integrating communities' clinical care and prevention systems.
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From page 196... ...
Health care delivery infrastructure can be compromised by loss of facilities; migration of health professionals away from the impacted area; and disruption of critical supports such as information and data technology, medical supplies and pharmaceuticals, transportation, and medically necessary social services (a more detailed description of disaster impacts on health is presented in Box 1-1 in Chapter 1)
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From page 197... ...
2. omplete an assessment of community health and social service needs and develop a comprehensive C recovery timeline.
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From page 198... ...
Healthcare Coalitions also may provide multi-agency coordination to interface with the appropriate level of emergency operations in order to assist with the provision of situational awareness and the coordination of resources for healthcare organizations during a response. SOURCE: Excerpted from ASPR, 2012, p.
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From page 199... ...
Task 2 Encourage healthcare organizations to identify the components of a fully functional COOP and develop corresponding plans for implementation. Task 3 If a disaster notice can be provided, alert healthcare organizations within communities threatened by disaster and if requested and feasible, assist them with the activation of COOP such that healthcare delivery to the community is minimally impacted.
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From page 200... ...
. This rule change has important implications in terms of transitioning to community-based models of care (e.g., utilization of community health workers)
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From page 201... ...
This makes it essential that health care providers and suppliers ensure that emergency management is integrated into their daily functions and values."7 CMS believes that the fragmented collection of current federal, state, and local laws and guidelines and accrediting organization emergency preparedness standards is inadequate for ensuring that health care providers and suppliers are prepared for a disaster. This assertion is based on extensive analysis of the literature and ongoing dialogue with various stakeholders and representatives of local, state, and federal entities.8 Consistent with the point made earlier in this chapter that building a comprehensive and integrated care delivery system is fundamental to creating maximally healthy and resilient communities, the committee was pleased to note that this proposed rule is aligned with and in fact cites the program guidance for emergency preparedness grants from HHS.
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From page 202... ...
Community health care is delivered through the interaction of hospitals, networks of outpatient providers, long-term care facilities, home health care and hospice, emergency medical services, behavioral health services, community and large chain pharmacies, and walk-in health services. A complex, sophisticated support system of financial, diagnostics, and logistics (e.g., supply chain, transportation)
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From page 203... ...
Therefore, it is imperative that outpatient care assets be integrated as the systems framework for disaster prepared BOX 6-5 Community Paramedicine Community paramedicine is an emerging model of collaborative, community-based health care in which emergency medical technicians and paramedics operate in expanded roles, beyond emergency response and transport. Community paramedicine utilizes the skills of emergency management personnel in addressing care gaps in the community to encourage more appropriate and efficient use of emergency care resources and to improve access to primary care, especially for underserved populations.
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From page 204... ...
C (5210) Ready Reserve Ready Reserve Corps members may Building a network of trained Corps be called to active duty to respond to professionals ready to respond national emergencies and public health in disasters who can be deployed crises and to fill critical public health to assist in any public health positions left vacant by members of emergency and augment response.6 the Regular Corps who have been called to duty elsewhere.
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From page 205... ...
outcomes could contribute to more standardized sharing of best practices.8 Title 9. A (9007, Community Health Imposes new requirements on 501(c)
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From page 206... ...
PRE-DISASTER HEALTH CARE SECTOR PRIORITIES The speed and success of the health care system's post-disaster recovery depend to a large extent on pre-disaster planning both within the health care sector and across sectors. A robust pre-disaster planning process also is key to capitalizing on the opportunities presented by a disaster to improve the health care system during the recovery process because it prepares the community to make the needed improvements.
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From page 207... ...
programs and systems that could be leveraged after a disaster; and • uilding an understanding of current program and system resources, capabilities, and needs (FEMA, b 2014a. This section identifies several key activities that should be undertaken prior to a disaster to increase the capacity of the health care sector to respond to the surge in health needs that may occur in the early recovery phase as well as to the long-term community health care needs that may arise later during the recovery period.
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From page 208... ...
To aid in these efforts, ASPR's HPP cooperative agreement supports the establishment of these coalitions and provides guidance on how they can strengthen a jurisdiction's medical surge and other health care preparedness capabilities. As highlighted in the 2012 IOM report Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response, health care coalitions have two key functions: • "Develop strategies and tactics to support emergency preparedness, response, and recovery activities of substate regional health care systems involving member organizations; and • Provide multiagency coordination for the interface with the appropriate level of emergency 13 A THIRA is a four-step process that assists the entire community, including individuals, businesses, faith-based organizations, nonprofit groups, schools, and governments, in determining and comprehending its risks and estimating capability requirements (FEMA, 2014b)
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From page 209... ...
. This guidance document identifies four important tasks associated with the implementation of COOP: • "Identify the healthcare essential services that must be continued to maintain healthcare delivery following a disaster; • Encourage healthcare organizations to identify the components of a fully functional COOP and develop corresponding plans for implementation; • If a disaster notice can be provided, alert healthcare organizations within communities threatened by disaster and if requested and feasible, assist them with the activation of COOP such that healthcare delivery to the community is minimally impacted; [and]
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From page 210... ...
Key features of strong coalitions are • collaborative and invested leadership; • ritten agreements specifying how and when the coalition is to be activated and its delegated w responsibilities; • trusted agency or entity to represent the facilities to the emergency management and public health a communities; • collaborative work in concrete response areas (e.g., regional HAZMAT training and planning) ; • inkages to cooperative agreements, grants, and programs such as the Hospital Preparedness l Program, Metropolitan Medical Response System, Urban Area Security Initiative, and the Centers for Disease Control and Prevention's (CDC's)
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From page 211... ...
Primary care providers Community-based organizations Community health centers Volunteer medical organizations (e.g., American Red Cross) Public health Tribal health care Federal entities (e.g., National Disaster Medical System, U.S.
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From page 212... ...
Federal legislation -- most notably the ACA and the Health Information Technology for Economic and Clinical Health Act,16 included in the American Recovery and Reinvestment Act of 2009 -- encourages the use and spread of health information technology. These two acts include specific provisions aimed at increasing the use of electronic health records throughout the health care sector, as well as the implementation of meaningful use guidelines with which to monitor and reward health care providers and organizations using the technology (ONC, 2012)
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From page 213... ...
Likewise, data from electronic health records, syndromic surveillance, and other sources can facilitate modeling, predictive analytics, and real-time situational awareness that informs pre-disaster planning and provides decision support during and after an event (IOM, 2014a)
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From page 214... ...
, "Disaster response and recovery operations are interdependent, overlapping, and often conducted concurrently." The assessment of community health and social service needs and of the recovery resources available to meet those needs may occur while response operations are ongoing. Further, health system recovery happens in phases, entailing a gradual/staged reintroduction of services.
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From page 215... ...
Such facilities must be able to accommodate auxiliary services to support staff. Important partners include state emergency management to help with permits and regulations, as well as utility companies to set up water, power, and communications infrastructure (e.g., to support access to electronic health records)
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From page 216... ...
Additionally, other local health care facilities that remain operational will likely experience a surge in people seeking care as a result of the community's reduced capacity. Temporary transfer of displaced medical staff to such facilities can help alleviate this burden.
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From page 217... ...
Coordinating Volunteers and Other Medical Professionals from Outside the Community Depending on the nature and scope of a disaster, local health care organizations may be bolstered by additional personnel with medical expertise (e.g., through the Emergency Management Assistance Compact and other mutual aid agreements)
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From page 218... ...
INTERMEDIATE- TO LONG-TERM RECOVERY: OPPORTUNITIES TO ADVANCE HEALTHIER AND MORE RESILIENT AND SUSTAINABLE COMMUNITIES Rebuilding Health Care Facilities After Disasters for Increased Resilience and Sustainability Health systems and services must be able to ensure continuous operation in disaster situations, particularly in light of the expected increase in the number and severity of disasters as a result of climate change. However, health systems themselves may contribute to climate change through high energy usage, carbon emissions, and use of chemical materials.
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From page 219... ...
Improving Health Care System Access and Quality of Care Reducing the social and economic costs of health care services through actions taken during recovery can contribute to a healthier and more resilient and sustainable community. Viewed through the lens of 17 The Best Practices Toolkit for Sustainable and Climate Resilient Health Care Facilities can be found at http://toolkit.climate.gov/ sites/default/files/SCRHCFI%20Best%20Practices%20Report%20final2%202014%20Web.pdf (accessed April 8, 2015)
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From page 220... ...
Nonhospital settings -- including ambulatory clinics, medical and dental offices, nursing homes, rehabilitative and assisted living centers, hospices, pharmacies, urgent and emergency services, and home health care services -- are essential to realizing maximally health communities. As noted earlier, moreover, the degree of integration of these services with each other and across the continuum of public health, prevention, behavioral health, and social services significantly determines overall community health and, relatedly, the resilience of the community.
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From page 221... ...
They exploited opportunities to leverage the work of other sectors -- for example, by working with community development organizations that fund community health centers. • Improved quality -- The plan established a team-based care and medical home model, and incorporated an all-hazards approach for effective emergency preparedness.
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From page 222... ...
Community health workers can facilitate the integration of health and human services partners (including health care, public health, social services, and housing) and have been shown to improve patient compliance with chronic disease management (see Box 6-13)
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From page 223... ...
focus on primary care and prevention delivered in community health centers that ideally are collocated with other community programs, such as day care and job training; (2) improve quality of care by creating the Louisiana Health Care Quality Forum; (3)
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From page 224... ...
. SUMMARY OF FINDINGS AND RECOMMENDATION While emergency responses that provide essential life-sustaining interventions in the immediate aftermath of a disaster take obvious priority at such times, preparing the health care delivery system for resilience before a disaster, restoring and preferably enhancing the health care infrastructure after a disaster, and engaging this rebuilt infrastructure more successfully in realizing healthier communities overall warrant increased attention and priority.
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From page 225... ...
A joint statement of global health organizations outlines the important roles played by CHWs in all phases of emergency management, from planning and prepared ness to response and recovery. For example, CHWs can prepare by identifying high-risk groups in the community and educating them about preparedness, and they can respond to a disaster by assessing community needs, providing psychosocial support, and referring individuals to appropriate health profes sionals (WHO et al., 2011)
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From page 226... ...
. This model identified sites around the community where it was critical for Gulf Coast Center staff to work and provide mental health care services, including the regional hospital, free clinics, a social services organization, and county jails.
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From page 227... ...
At the federal level, the Office of the National Coordinator for Health Information Technology should build on its current efforts and develop a 3-year implementation plan for health information technology integration. This plan should be designed to facilitate data sharing and portability of individual health records across health care settings in support of pre- and post-disaster recovery health planning and optimal recovery of essential infrastructure for medical and behavioral health care, public health, and social services.
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From page 228... ...
The checklist illustrates how the following 4 key recovery strategies, identified as recurring themes at the beginning of this chapter, apply to individual priority areas: • Use multidisciplinary team-based care strategies to meet multifaceted health care needs; • Ensure continuity of access to health care services; • Use health information technology to drive decision making for individual and community health, and to inform future planning; • Leverage health care coalitions and other relationships with local care providers for health services strategic decision making and alignment of clinical resources.
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From page 229... ...
Priority: Establish, Sustain, and Exercise Health Care Coalitions and Other Coordinating Groups Primary Actors: Health and Medical System Partners, State/Local Health Departments Key Partners: Emergency Management Agencies Key Recovery Strategy: • Leverage health care coalitions and other multisector partnerships among local care providers for health services strategic decision making, alignment of clinical resources, and coordination with public health and emergency management sectors. 1 See Appendix F for further description of terms used to describe Primary Actors and Key Partners in this checklist.
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From page 230... ...
• Use health information technology to drive decision making for individual and community health and to inform future iterations of planning. • Leverage health care coalitions and other relationships among local care providers for health services strategic decision making, alignment of clinical resources, and coordination with public health and emergency management sectors.
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From page 231... ...
that is essential to the continuity of health care and social services delivery across the continuum of disaster response and recovery. − romote and support the adoption of electronic health records.
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From page 232... ...
I Priority: Restore Care Delivery Infrastructure and Services Primary Actors: Health and Medical System Partners, State/Local Health Departments Key Partners: Behavioral Health Authorities, Social Services Agencies Key Recovery Strategies: • Leverage health care coalitions and other relationships among local care providers for health services strategic decision making, alignment of clinical resources, and coordination with public health and emergency management sectors. • Use multidisciplinary team-based care strategies to meet multifaceted health care needs.
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From page 233... ...
Priority: Locate and Meet Needs of At-Risk Community Members with Special Medical Needs Primary Actors: State/Local Health Departments Key Partners: Health and Medical System Partners, Emergency Management Agencies, Community- and Faith-based Organizations Key Recovery Strategies: • Use team-based care strategies to meet multifaceted clinical care needs. • Use health information technology to drive decision making for individual and community health and to inform future iterations of planning.
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From page 234... ...
Priority: Coordinate Provision of Clinical Services Primary Actors: Health and Medical System Partners Key Partners: State/Local Health Departments, Social Services Agencies, Behavioral Health Authorities, Emergency Management Agencies Key Recovery Strategies: • Leverage health care coalitions and other relationships among local care providers for health services strategic decision making, alignment of clinical resources, and coordination with public health and emergency management sectors. • Use team-based care strategies to meet multifaceted clinical care needs.
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From page 235... ...
C £ tilize aggregate data from health IT systems to evaluate ongoing clinical care needs and U changes to patient demographics. Priority: Rebuild Health Care Facilities After Disasters for Increased Resilience and Sustainability Primary Actors: Health and Medical System Partners, State/Local Health Departments Key Partners: Emergency Management Agencies Key Recovery Strategies: • Leverage health care coalitions and other relationships among local care providers for health services strategic decision making, alignment of clinical resources, and coordination with public health and emergency management sectors.
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From page 236... ...
. Priority: Improve Health Care System Access and Quality of Care Primary Actors: Health and Medical System Partners, State/Local Health Departments Key Partners: Emergency Management Agencies, Urban and Regional Planning Agencies, Community Development Organizations Key Recovery Strategies: • Leverage health care coalitions and other relationships among local care providers for health services strategic decision making, alignment of clinical resources, and coordination with public health and emergency management sectors.
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From page 237... ...
Activities include but are not limited to: £ pdate COOP plans based on lessons learned. U £ articipate in after-action process, including analysis of lessons learned and identification P of opportunities for improvement.
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From page 238... ...
2007. Use of electronic health records in disaster response: The experience of Department of Veterans Affairs after Hurricane Katrina.
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From page 239... ...
2014. Community health workers prove the key to Philippines relief efforts.
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From page 240... ...
2006. Effectiveness of community health workers in the care of persons with diabetes.
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From page 241... ...
2011. Capacity building for post-disaster mental health since Katrina: The role of community health workers.
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