102 Evaluation of Disaster Risk and Health Care Response in 12 US Cities

Abstract

Cities are a diverse ecosystem of individuals, health care, and the built and natural environment that all contribute to their risk as well as readiness to respond in the event of a disaster. Various factors contribute to the risk a city faces for natural and manmade disasters, and the health care system is an essential component of a city’s ability to respond to the medical needs of individuals. The National Quality Forum (NQF) is creating a measurement framework for hospital readiness. We calculated a risk score for US cities using regional factors and evaluated health system capacity within each city. Twelve cities were evaluated using over 30 variables and three sub-themes (Figure 1) from data sources including NOAA, FEMA, US Census Bureau, US Geological Survey, American Highway Users Alliance, US Immigration and Customs Enforcement, Bureau of Land Management, National Pipeline Mapping System, International Tanker Owners Pollution Federation, Stadium Managers Association, and CDC. For each city, percentile ranks were generated for each of the individual variables. Scores for each variable within a sub-theme (infrastructure, environment, population) were then averaged to create that subtheme’s score. This process was repeated to create the overall city risk score from the three subtheme scores. Cities were ranked using percentiles (range 0-1) with higher values indicating greater exposure to disaster risk. Health system descriptive statistics were estimated at the city level using data reported from multiple CMS data files and from the American Hospital Survey. Overall risk scores ranged from 0.40 (Denver) to 0.71 (New York) (mean 0.56, SD 0.09). Sub-scores ranged from 0.37 (Cincinnati) to 0.78 (Los Angeles) for infrastructure; 0.40 (Denver) to 0.75 (Orlando) for environment; and 0.33 (Denver) to 0.71 (New York) for population. The health care system in high and low risk cities varied, with 40 major hospitals present in the 5 New York boroughs and 8 in Denver. A total of 8 hospitals in New York were designated as a level I trauma center (4 Level II) compared with 0 in Denver, (4 level II). New York had 215,567.5 residents/hospital vs 89,561.5 in Denver. An average of 9% of total beds were designated for the ICU in New York (1,878 ICU of 21,058 total beds) compared with 14% in Denver (397 ICU of 2,862 total beds). The median occupancy rates in New York were 81% (IQR: 71-86) vs 65% (IQR: 47-71) in Denver, with significant differences in average mean boarding time (214.32 minutes New York vs 80.57 minutes Denver, p-value <0.001). Infrastructure, environment, and population factors can be quantified to describe a city’s disaster risk score. Health system factors can be used to describe the capacity of regional health systems to manage the acute care needs of the population during disasters. The ratio of risk to readiness provides an objective mechanism by which to achieve the NQF’s goal of benchmarking health system readiness at the community level.