Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-14T17:24:45.509Z Has data issue: false hasContentIssue false
  • English
  • Français

Developing Valid Measures of Emergency Management Capabilities within US Department of Veterans Affairs Hospitals

Published online by Cambridge University Press:  05 August 2016

Aram Dobalian ,
Judith A. Stein ,
Tiffany A. Radcliff ,
Deborah Riopelle ,
Pete Brewster ,
Farhad Hagigi  and
Claudia Der-Martirosian
Aram Dobalian*
Affiliation:
Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CaliforniaUSA Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CaliforniaUSA School of Nursing, University of California, Los Angeles, CaliforniaUSA Center for the Study of Healthcare Innovation, Implementation and Policy, US Department of Veterans Affairs, North Hills, CaliforniaUSA
Judith A. Stein
Affiliation:
Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CaliforniaUSA
Tiffany A. Radcliff
Affiliation:
Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CaliforniaUSA Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TexasUSA
Deborah Riopelle
Affiliation:
Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CaliforniaUSA Center for the Study of Healthcare Innovation, Implementation and Policy, US Department of Veterans Affairs, North Hills, CaliforniaUSA
Pete Brewster
Affiliation:
Office of Emergency Management, Veterans Health Administration, US Department of Veterans Affairs, Martinsburg, West VirginiaUSA
Farhad Hagigi
Affiliation:
Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CaliforniaUSA Department of Family Medicine, Geffen School of Medicine, University of California, Los Angeles, CaliforniaUSA
Claudia Der-Martirosian
Affiliation:
Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CaliforniaUSA
*
Correspondence: Aram Dobalian, PhD, JD, MPH Director, VEMEC 16111 Plummer St MS-152 North Hills, California 91343 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Conclusion

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.

DobalianA, SteinJA, RadcliffTA, RiopelleD, BrewsterP, HagigiF, Der-MartirosianC. Developing Valid Measures of Emergency Management Capabilities within US Department of Veterans Affairs Hospitals. Prehosp Disaster Med. 2016;31(5):475–484.

Keywords

disastersemergency preparednesshospitalsquality improvementUnited States Department of Veterans Affairs
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 5 , October 2016 , pp. 475 - 484
Copyright
© World Association for Disaster and Emergency Medicine 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Sauer, LM, McCarthy, ML, Knebel, A, Brewster, P. Major influences on hospital emergency management and disaster preparedness. Disaster Med Public Health Prep. 2009;3(2 Suppl):S68-S73.Google Scholar
2. Buyum, A, Dubruiel, N, Torghele, K, Alperin, M, Miner, KR. Can summits lead to curricula change? An evaluation of emergency preparedness summits for schools of nursing in Georgia. J Contin Educ Nurs. 2009;40(5):210-215.CrossRefGoogle ScholarPubMed
3. Ferrer, RR, Ramirez, M, Sauser, K, Iverson, E, Upperman, JS. Emergency drills and exercises in health care organizations: assessment of pediatric population involvement using after-action reports. Am J Disaster Med. 2009;4(1):23-32.Google Scholar
4. Levy, LA, Rokusek, CF, Bragg, SM, Howell, JT. Interdisciplinary approach to all-hazards preparedness: are you ready? How do we know? J Public Health Manag Pract. 2009;15(2 Suppl):S8-12.CrossRefGoogle ScholarPubMed
5. Wang, C, Wei, S, Xiang, H, et al. Development and evaluation of a leadership training program for public health emergency response: results from a Chinese study. BMC Public Health. 2008;8:377.Google Scholar
6. Barbera, JA, Yeatts, DJ, Macintyre, AG. Challenge of hospital emergency preparedness: analysis and recommendations. Disaster Med Public Health Prep. 2009;3(2 Suppl):S74-S82.Google Scholar
7. Adini, B, Goldberg, A, Laor, D, Cohen, R, Zadok, R, Bar-Dayan, Y. Assessing levels of hospital emergency preparedness. Prehosp Disaster Med. 2006;21(6):451-457.CrossRefGoogle ScholarPubMed
8. Adini, B, Goldberg, A, Cohen, R, Laor, D, Bar-Dayan, Y. Evidence-based support for the all-hazards approach to emergency preparedness. Isr J Health Policy Res. 2012;1(1):40.Google Scholar
9. Adini, B, Laor, D, Hornik-Lurie, T, Schwartz, D, Aharonson-Daniel, L. Improving hospital mass casualty preparedness through ongoing readiness evaluation. Am J Med Qual. 2012;27(5):426-433.Google Scholar
10. Kaji, AH, Langford, V, Lewis, RJ. Assessing hospital disaster preparedness: a comparison of an on-site survey, directly observed drill performance, and video analysis of teamwork. Ann Emerg Med. 2008;52(3):195-201; 201 e191-112.Google Scholar
11. Jenkins, JL, Kelen, GD, Sauer, LM, Fredericksen, KA, McCarthy, ML. Review of hospital preparedness instruments for National Incident Management System compliance. Disaster Med Public Health Prep. 2009;3(2 Suppl):S83-S89.Google Scholar
12. McCarthy, ML, Brewster, P, Hsu, EB, Macintyre, AG, Kelen, GD. Consensus and tools needed to measure health care emergency management capabilities. Disaster Med Public Health Prep. 2009;3(2 Suppl):S45-S51.Google Scholar
13. Barbisch, DF, Koenig, KL. Understanding surge capacity: essential elements. Acad Emerg Med. 2006;13(11):1098-1102.Google Scholar
14. Legemaate, GA, Burkle, FM Jr., Bierens, JJ. The evaluation of research methods during disaster exercises: applicability for improving disaster health management. Prehosp Disaster Med. 2012;27(1):18-26.Google Scholar
15. Zhong, S, Clark, M, Hou, XY, Zang, Y, FitzGerald, G. Development of key indicators of hospital resilience: a modified Delphi study. J Health Serv Res Policy. 2015;20(2):74-82.Google Scholar
16. Ingrassia, PL, Prato, F, Geddo, A, et al. Evaluation of medical management during a mass casualty incident exercise: an objective assessment tool to enhance direct observation. J Emerg Med. 2010;39(5):629-636.Google Scholar
17. Adini, B, Goldberg, A, Cohen, R, Bar-Dayan, Y. Relationship between standards of procedures for pandemic flu and level of hospital performance in simulated drills. Ann Emerg Med. 2008;52(3):223-229.Google Scholar
18. Kaji, AH, Lewis, RJ. Hospital disaster preparedness in Los Angeles County. Acad Emerg Med. 2006;13(11):1198-1203.Google Scholar
19. Macintyre, AG, Barbera, JA, Brewster, P. Health care emergency management: establishing the science of managing mass casualty and mass effect incidents. Disaster Med Public Health Prep. 2009;3(2 Suppl):S52-S58.Google Scholar
20. Higgins, W, Wainright, C III, Lu, N, Carrico, R. Assessing hospital preparedness using an instrument based on the Mass Casualty Disaster Plan Checklist: results of a statewide survey. Am J Infect Control. 2004;32(6):327-332.CrossRefGoogle ScholarPubMed
21. Hick, JL, Koenig, KL, Barbisch, D, Bey, TA. Surge capacity concepts for health care facilities: the CO-S-TR model for initial incident assessment. Disaster Med Public Health Prep. 2008;2(Suppl 1):S51-S57.Google Scholar
22. Hick, JL, Barbera, JA, Kelen, GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009;3(2 Suppl):S59-S67.Google Scholar
23. Hick, JL, Christian, MD, Sprung, CL, European Society of Intensive Care Medicine’s task force for intensive care unit triage during an influenza epidemic or mass disaster. Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010;36(Suppl 1):S11-S20.Google Scholar
24. Hick, JL, Hanfling, D, Cantrill, SV. Allocating scarce resources in disasters: emergency department principles. Ann Emerg Med. 2012;59(3):177-187.Google Scholar
25. Kaji, A, Koenig, KL, Bey, T. Surge capacity for health care systems: a conceptual framework. Acad Emerg Med. 2006;13(11):1157-1159.Google Scholar
26. Dobalian, A, Callis, R, Davey, VJ. Evolution of the Veterans Health Administration’s role in emergency management since September 11, 2001. Disaster Med Public Health Prep. 2011;5(Suppl 2):S182-S184.Google Scholar
27. Bentler, PM. EQS 6 Structural Equations Program Manual. Encino, California USA: Multivariate Software; 2006.Google Scholar
28. Hu, L-t, Bentler, PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling. 1999;6(1):1-55.Google Scholar
29. Chou, C-p, Bentler, PM. Model modification in covariance structure modeling: a comparison among likelihood ratio, Lagrange Multiplier, and Wald tests. Multivariate Behavioral Research. 1990;25(1):115-136.Google Scholar