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

被引:15
作者
Dobalian, Aram [1 ,2 ,3 ,4 ]
Stein, Judith A. [1 ]
Radcliff, Tiffany A. [1 ,5 ]
Riopelle, Deborah [1 ,4 ]
Brewster, Pete [6 ]
Hagigi, Farhad [1 ,7 ]
Der-Martirosian, Claudia [1 ]
机构
[1] US Dept Vet Affairs, Vet Emergency Management Evaluat Ctr, North Hills, CA USA
[2] Univ Calif Los Angeles, Dept Hlth Policy & Management, Fielding Sch Publ Hlth, Los Angeles, CA USA
[3] Univ Calif Los Angeles, Sch Nursing, Los Angeles, CA 90024 USA
[4] US Dept Vet Affairs, Ctr Study Healthcare Innovat Implementat & Policy, North Hills, CA USA
[5] Texas A&M Univ, Dept Hlth Policy & Management, Sch Publ Hlth, College Stn, TX USA
[6] US Dept Vet Affairs, Off Emergency Management, Vet Hlth Adm, Martinsburg, WV USA
[7] Univ Calif Los Angeles, Dept Family Med, Geffen Sch Med, Los Angeles, CA USA
关键词
disasters; emergency preparedness; hospitals; quality improvement; United States Department of Veterans Affairs; SURGE CAPACITY; DISASTER PREPAREDNESS; MASS CASUALTY; CARE; PERFORMANCE; MODEL;
D O I
10.1017/S1049023X16000625
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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.
引用
收藏
页码:475 / 484
页数:10
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