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Comparative Study
. 2012 Feb;13(2):190.e1-7.
doi: 10.1016/j.jamda.2011.07.011. Epub 2011 Aug 31.

To evacuate or shelter in place: implications of universal hurricane evacuation policies on nursing home residents

David Dosa  1 , Kathryn Hyer, Kali Thomas, Shailender Swaminathan, Zhanlian Feng, Lisa Brown, Vincent Mor
Affiliations
Comparative Study

To evacuate or shelter in place: implications of universal hurricane evacuation policies on nursing home residents

David Dosa et al. J Am Med Dir Assoc. 2012 Feb.

Abstract

Objective: To examine the differential morbidity/mortality associated with evacuation versus sheltering in place for nursing home (NH) residents exposed to the 4 most recent Gulf hurricanes.

Methods: Observational study using Medicare claims and NH data sources. We compared the differential mortality/morbidity for long-stay residents exposed to 4 recent hurricanes (Katrina, Rita, Gustav, and Ike) relative to those residing at the same NHs over the same time periods during the prior 2 nonhurricane years as a control. Using an instrumental variable analysis, we then evaluated the independent effect of evacuation on outcomes at 90 days.

Results: Among 36,389 NH residents exposed to a storm, the 30- and 90-day mortality/hospitalization rates increased compared with nonhurricane control years. There were a cumulative total of 277 extra deaths and 872 extra hospitalizations at 30 days. At 90 days, 579 extra deaths and 544 extra hospitalizations were observed. Using the instrumental variable analysis, evacuation increased the probability of death at 90 days from 2.7% to 5.3% and hospitalization by 1.8% to 8.3%, independent of other factors.

Conclusion: Among residents exposed to hurricanes, evacuation significantly exacerbated subsequent morbidity/mortality.

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Figures

Figure 1
Figure 1
Actual versus Predicted Mortality Rates Associated with Hurricane Exposure among Nursing Home Residents
Figure 2
Figure 2
Actual versus Predicted Hospitalization Rates Associated with Hurricane Exposure among Nursing Home Residents
See this image and copyright information in PMC

References

    1. Dosa D, Hyer K, Brown L, Artenstein A, Polivka-West L, Mor V. The Controversy Inherent in Managing Frail Nursing Home Residents during Complex Hurricane Emergencies. J Am Med Dir Assoc. 2008;9:599–604. - PubMed
    1. United States Government Accountability Office Disaster preparedness: Limitations in federal evacuation assistance for health facilities should be addressed. Report to Congressional Committees. Jul, 2006. pp. 1–52. In: GAO-06-826.
    1. Blanchard G, Dosa D. A Comparison of the Nursing Home Evacuation Experience between Hurricanes Katrina (2005) and Gustav (2008) J Am Med Dir Assoc. 2009;10:639–43. - PMC - PubMed
    1. Dosa D, Feng Z, Hyer K, Brown LM, Thomas K, Mor V. The Effects of Hurricane Katrina on Nursing Home Resident Mortality, Hospitalizations and Functional Decline. Disaster Med Public Health Prep. 2010;4:1–5. - PMC - PubMed
    1. Office of Inspector General Nursing home emergency preparedness and response during recent hurricanes: OEI-06-06-00020. Aug, 2006. Report No.: OEI-06-06-00020.

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