title: Developing Valid Measures of Emergency Management Capabilities within US Department of Veterans Affairs Hospitals.
abstract: Introduction Hospitals play a critical role in providing health care in the aftermath of disasters and emergencies. Nonetheless, while multiple tools exist to assess hospital disaster preparedness, existing instruments have not been tested adequately for validity. Hypothesis/Problem This study reports on the development of a preparedness assessment tool for hospitals that are part of the US Department of Veterans Affairs (VA; Washington, DC USA).
  
  
  METHODS
  The authors evaluated hospital preparedness in six "Mission Areas" (MAs: Program Management; Incident Management; Safety and Security; Resiliency and Continuity; Medical Surge; and Support to External Requirements), each composed of various observable hospital preparedness capabilities, among 140 VA Medical Centers (VAMCs). This paper reports on two successive assessments (Phase I and Phase II) to assess the MAs' construct validity, or the degree to which component capabilities relate to one another to represent the associated domain successfully. This report describes a two-stage confirmatory factor analysis (CFA) of candidate items for a comprehensive survey implemented to assess emergency preparedness in a hospital setting.
  
  
  RESULTS
  The individual CFAs by MA received acceptable fit statistics with some exceptions. Some individual items did not have adequate factor loadings within their hypothesized factor (or MA) and were dropped from the analyses in order to obtain acceptable fit statistics. The Phase II modified tool was better able to assess the pre-determined MAs. For each MA, except for Resiliency and Continuity (MA 4), the CFA confirmed one latent variable. In Phase I, two sub-scales (seven and nine items in each respective sub-scale) and in Phase II, three sub-scales (eight, four, and eight items in each respective sub-scale) were confirmed for MA 4. The MA 4 capabilities comprise multiple sub-domains, and future assessment protocols should consider re-classifying MA 4 into three distinct MAs.
  
  
  CONCLUSIONS
  The assessments provide a comprehensive and consistent, but flexible, approach for ascertaining health system preparedness. This approach can provide an organization with a clear understanding of areas for improvement and could be adapted into a standard for hospital readiness. Dobalian A , Stein JA , Radcliff TA , Riopelle D , Brewster P , Hagigi F , Der-Martirosian C . Developing valid measures of emergency management capabilities within US Department of Veterans Affairs hospitals. Prehosp Disaster Med. 2016;31(5):475-484.
authors: 1Veterans Emergency Management Evaluation Center,US Department of Veterans Affairs,North Hills,CaliforniaUSA.
authors: Aram
authors: A
authors: Dobalian
authors: 1Veterans Emergency Management Evaluation Center,US Department of Veterans Affairs,North Hills,CaliforniaUSA.
authors: Judith A
authors: JA
authors: Stein
authors: 1Veterans Emergency Management Evaluation Center,US Department of Veterans Affairs,North Hills,CaliforniaUSA.
authors: Tiffany A
authors: TA
authors: Radcliff
authors: 1Veterans Emergency Management Evaluation Center,US Department of Veterans Affairs,North Hills,CaliforniaUSA.
authors: Deborah
authors: D
authors: Riopelle
authors: 6Office of Emergency Management,Veterans Health Administration,US Department of Veterans Affairs,Martinsburg,West VirginiaUSA.
authors: Pete
authors: P
authors: Brewster
authors: 1Veterans Emergency Management Evaluation Center,US Department of Veterans Affairs,North Hills,CaliforniaUSA.
authors: Farhad
authors: F
authors: Hagigi
authors: 1Veterans Emergency Management Evaluation Center,US Department of Veterans Affairs,North Hills,CaliforniaUSA.
authors: Claudia
authors: C
authors: Der-Martirosian
mesh_terms: D002959:Civil Defense / Q000592:standards*; D005163:Factor Analysis, Statistical; D006787:Hospitals, Veterans; D006801:Humans; D019984:Quality Indicators, Health Care; D014481:United States
keywords: CEMP Comprehensive Emergency Management Program; CFA confirmatory factor analysis; CFI Comparative Fit Index; MA Mission Area; RCFI Robust Comparative Fit Index; United States Department of Veterans Affairs; VA US Department of Veterans Affairs; VAMC VA Medical Center; WHO World Health Organization; disasters; emergency preparedness; hospitals; quality improvement