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1. Background and Introduction
Approximately 7.6 million individuals receive care in their home from 17,000 home care providers because of acute illness, long-term care conditions, permanent disability, or terminal illness (1). Technological advances have expanded the capabilities of home care providers so that many chronic conditions that previously would have been cared for in the hospital are now being safely managed in the home. Intravenous (IV) infusion technology, parenteral nutrition, peritoneal dialysis, oxygen therapy, feeding pumps, ventilators, pulse oximeters, and hand-held blood analysis devices are just a few examples of the common devices that have allowed the expansion of home care (2,3).
During a mass casualty event (MCE), these community-dwelling patients could experience disruption of needed support services. Depending on the level of their needs, a disruption of care/services could lead to patient decompensation and increased reliance on acute care services, including emergency medical systems and hospital emergency departments (EDs) already stretched thin by the disaster situation. For example, Greenwald et al. (4) found that during the August 2003 North American electrical blackout, 23 of 255 patients who required ED care presented with medical device failure; 13 of these patients were admitted to the hospital, accounting for 22 percent of all admissions during the blackout. The patients most affected by a disruption of services are those with the most complex treatment/equipment needs that cannot be met by family members or other informal caregivers.
Abt Associates, along with its partners from the Brigham and Women's Hospital and Massachusetts General Hospital in Boston, was contracted by the Agency for Healthcare Research and Quality to develop a model patient risk assessment tool that rates the risk status of community-based patients in the event of a disaster. The goal for such a tool is for home health agencies (HHAs) and others to be able to identify and count the number of individuals/patients who would be most at risk of hospitalization if their home supports and services were disrupted during an emergency. All community-dwelling patients would be considered at risk during an MCE. This study, however, focuses on those whose needs are most complex—those patients who could not be safely evacuated to a public shelter or even a special needs shelter during an MCE. With this information, emergency planners could begin to anticipate and prepare for this additional surge demand.
The objective of this study is not to design a home care triage tool for use in the midst of an MCE. Rather, the purpose is to develop a patient risk assessment tool that will allow home care agencies, hospitals, and emergency planners to anticipate the needs of all home care patients in a community, should an MCE occur.
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