title: Prediction of unmet primary care needs for the medically vulnerable post-disaster: an interrupted time-series analysis of health system responses.
abstract: 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.
authors.affiliation: Nell Hodgson School of Nursing, Emory University, Atlanta, GA 30322, USA. jennifer.r.runkle@emory.edu
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Runkle
authors.forename: Hongmei
authors.initials: H
authors.lastname: Zhang
authors.forename: Wilfried
authors.initials: W
authors.lastname: Karmaus
authors.forename: Amy B
authors.initials: AB
authors.lastname: Martin
authors.forename: Erik R
authors.initials: ER
authors.lastname: Svendsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D055884:Chemical Hazard Release; D002713:Chlorine; D004190:Disasters; D006297:Health Services Accessibility; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data*; D008507:Medically Underserved Area; D008875:Middle Aged; D008962:Models, Theoretical; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013022:South Carolina; D055872:Surge Capacity / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
chemical_list: D002713:Chlorine