title: The role of the home-based provider in disaster preparedness of a vulnerable population.
abstract: BACKGROUND
  Veterans receiving home-based primary care (HBPC) are an especially vulnerable population served by the Veterans Health Administration (VHA) due to high rates of physical, functional, and psychological limitations. These vulnerabilities may prevent these persons from being adequately prepared for disasters. HBPC providers connect the community-dwelling population with their regional health care system and thus are appropriate partners for assessing preparedness. The limited literature on this topic suggests that there are issues with the development and implementation of emergency management plans, dissemination to staff, and inconsistencies with preparedness strategies across agencies.
  
  
  OBJECTIVE
  To further explore identified issues regarding emergency management planning for patients receiving medical care in their home, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients.
  
  
  METHODS
  This exploratory pilot project, carried out in a single VHA HBPC program located in an urban area, involved seven 15- to 25-min semistructured interviews with practitioners and leadership. Transcripts of the interviews were analyzed using content analysis techniques to develop themes to describe information obtained through the interviews.
  
  
  RESULTS
  Six themes emerged from the data: (1) a national policy regarding the inclusion of disaster preparedness assessment in routine HBPC assessment exists in only a skeletal manner and individual HBPC programs are tasked with developing their own policies; (2) the tools used at the initial assessment were rudimentary and, in some cases, individually developed by providers; (3) the comprehension of criteria for assigning risk categories (i.e. acuity levels) varied among providers; (4) the primary challenges identified by respondents to patient engagement in emergency preparedness activities included cognitive impairments, patients' willingness to invest in preparedness activities, and limited resources; (5) providers received limited formal training on how to prepare their patients for a disaster, and (6) provider recommendations included training to focus on better strategies to get patients to participate, more consistent time spent on patient education, formalization of the initial assessment, and having emergency preparedness be formally addressed on a more consistent basis.
  
  
  CONCLUSIONS
  Formal standardized strategies regarding disaster preparedness assessment for HBPC patients, which leave room for flexibility in consideration of local factors, could assist in creating more comprehensive emergency management planning agendas and community collaboration.
authors.affiliation: Veterans Emergency Management Evaluation Center (VEMEC), Sepulveda, Calif., USA.
authors.forename: Tamar
authors.initials: T
authors.lastname: Wyte-Lake
authors.forename: Maria
authors.initials: M
authors.lastname: Claver
authors.forename: Anne
authors.initials: A
authors.lastname: Griffin
authors.forename: Aram
authors.initials: A
authors.lastname: Dobalian
mesh_terms: D000368:Aged; D002959:Civil Defense; D004189:Disaster Planning / Q000379:methods*; D006282:Health Personnel; D006699:Home Care Services; D006801:Humans; D010865:Pilot Projects; D011320:Primary Health Care; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D035862:Vulnerable Populations