scholarly journals A Systems Approach and Notional Response Model for Preserving the Health System during the COVID-19 Pandemic

2020 ◽  
Vol 5 (2) ◽  
pp. p47
Author(s):  
James F. Goss ◽  
Steven Berkshire ◽  
Asa B. Wilson ◽  
Kathleen M. Jordan
Keyword(s):  
New York ◽  
Health System ◽  
Federal Government ◽  
Systems Approach ◽  
Disease Outbreak ◽  
Disease Spread ◽  
Response Model ◽  
Outbreak Response ◽  
Collective Experience ◽  
Synthesis Approach

During any pandemic, it has long been known that local jurisdictions would need to be self-sufficient with little or no outside assistance, particularly from the federal government. While all eyes have been on California, New York, and Massachusetts, the capacities of health systems in other states have yet to be put to the test. If there are subsequent waves of COVID-19 and other jurisdictions see significant increases in disease spread, the systems used to respond will become critical.Using a review and synthesis approach, this article explores our collective experience and knowledge as it pertains to use of alternate care sites for dealing with the patient surge created by a disease outbreak. Probing the concept of alternate care site (ACS) systems reveals various types of alternate care sites that may be employed during an outbreak. The historical value of ACS models used during outbreak response are discussed. This culminates in the development of a notional response model and list of actions that should be taken by all jurisdictions as we prepare for additional waves of disease.

PyDOSS: An open-source Python-based communicable disease outbreak surveillance system designed and used in a COVID-19 community care facility (Preprint)

2020 ◽  
Author(s):  
Andrew Fang ◽  
Jonathan Kia-Sheng Phua ◽  
Terrence Chiew ◽  
Daniel De-Liang Loh ◽  
Lincoln Ming Han Liow ◽  
...  
Keyword(s):  
Open Source ◽  
Surveillance System ◽  
Community Care ◽  
Communicable Disease ◽  
Low Cost ◽  
Real Life ◽  
Disease Outbreak ◽  
Disease Spread ◽  
Healthcare Team ◽  
Increased Risk

BACKGROUND During the Coronavirus Disease 2019 (COVID-19) outbreak, community care facilities (CCF) were set up as temporary out-of-hospital isolation facilities to contain the surge of cases in Singapore. Confined living spaces within CCFs posed an increased risk of communicable disease spread among residents. OBJECTIVE This inspired our healthcare team managing a CCF operation to design a low-cost communicable disease outbreak surveillance system (CDOSS). METHODS Our CDOSS was designed with the following considerations: (1) comprehensiveness, (2) efficiency through passive reconnoitering from electronic medical record (EMR) data, (3) ability to provide spatiotemporal insights, (4) low-cost and (5) ease of use. We used Python to develop a lightweight application – Python-based Communicable Disease Outbreak Surveillance System (PyDOSS) – that was able perform syndromic surveillance and fever monitoring. With minimal user actions, its data pipeline would generate daily control charts and geospatial heat maps of cases from raw EMR data and logged vital signs. PyDOSS was successfully implemented as part of our CCF workflow. We also simulated a gastroenteritis (GE) outbreak to test the effectiveness of the system. RESULTS PyDOSS was used throughout the entire duration of operation; the output was reviewed daily by senior management. No disease outbreaks were identified during our medical operation. In the simulated GE outbreak, PyDOSS was able to effectively detect an outbreak within 24 hours and provided information about cluster progression which could aid in contact tracing. The code for a stock version of PyDOSS has been made publicly available. CONCLUSIONS PyDOSS is an effective surveillance system which was successfully implemented in a real-life medical operation. With the system developed using open-source technology and the code made freely available, it significantly reduces the cost of developing and operating CDOSS and may be useful for similar temporary medical operations, or in resource-limited settings.

scholarly journals Strategies for responding to the COVID-19 pandemic in a rural health system in New York state

Healthcare ◽  
2021 ◽  
pp. 100508
Author(s):  
Jamie A. Aron ◽  
Alex JB. Bulteel ◽  
Kelsey A. Clayman ◽  
Joseph A. Cornett ◽  
Kerry Filtz ◽  
...  
Keyword(s):  
New York ◽  
Health System ◽  
Rural Health ◽  
New York State ◽  
York State

scholarly journals Engaging and Educating Older Adults and Caregivers in Age-Friendly Healthcare

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 686-686
Author(s):  
Erin Emery-Tiburcio ◽  
Rani Snyder
Keyword(s):  
Older Adults ◽  
New York ◽  
Health System ◽  
Medical Center ◽  
Health Resources ◽  
Primary Care Providers ◽  
Care Providers ◽  
New York University ◽  
The Us ◽  
Treatment Plans

Abstract As the Age-Friendly Health System initiative moves across the US and around the world, not only do health system staff require education about the 4Ms, but older adults, caregivers, and families need education. Engaging and empowering the community about the 4Ms can improve communication, clarify and improve adherence to treatment plans, and improve patient satisfaction. Many methods for engaging the community in age-friendly care are currently in development. Initiated by Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Programs (GWEPs), Community Catalyst is leading the co-design of Age-Friendly Health System materials with older adults and caregivers. Testing these materials across the country in diverse populations of older adults and caregivers will yield open-source documents for local adaptation. Rush University Medical Center is testing a method for identifying, engaging, educating, and providing health services for family caregivers of older adults. This unique program integrates with the Age-Friendly Health System efforts in addressing all 4Ms for caregivers. The Bronx Health Corps (BHC) was created by the New York University Hartford Institute of Geriatric Nursing to educate older adults in the community about health and health behaviors. BHC developed a method for engaging and educating older adults that is replicable in other communities. Baylor College of Medicine adapted and tested the Patient Priorities Care model to educate primary care providers about how to engage older adults in conversations about What Matters to them. Central to the Age-Friendly movement, John A. Hartford Foundation leadership will discuss the implications of this important work.

scholarly journals Promoting a Therapeutic Healing Environment: A Retrospective Examination of HCAHPS “Quiet at Night” Across a Large New York Health System

2021 ◽  
Vol 8 ◽  
pp. 237437352110565
Author(s):  
Agnes Barden ◽  
Amy E Loeb ◽  
Nicole Giammarinaro
Keyword(s):  
New York ◽  
Health System ◽  
National Database ◽  
Patient Centered ◽  
Healing Environment ◽  
Patient Feedback ◽  
Leadership Accountability ◽  
Percentile Rank ◽  
The Press ◽  
Adult Inpatient

Promoting respite and sleep impacts a patient's health and their inpatient experience. As New York State's largest health system, Northwell Health has been on a journey to create a healing and therapeutic healthcare environment. By establishing leadership accountability, leveraging patient feedback and adopting evidence-based interventions, system and individual adult inpatient hospital improvements have been noted. Between 2017 and 2020, Northwell's overall system HCAHPS “Quiet at Night” Top Box performance increased by 4.7, improving 30 percentile rank points when compared to the Press Ganey national database. This case study outlines Northwell's pragmatic patient-centered strategy and examines the unanticipated impact of limited visitation due to COVID-19 on this HCAHPS measure.

scholarly journals Host size and proximity to diseased neighbours drive the spread of a coral disease outbreak in Hawai‘i

2018 ◽  
Vol 285 (1870) ◽  
pp. 20172265 ◽  
Author(s):  
Jamie M. Caldwell ◽  
Megan J. Donahue ◽  
C. Drew Harvell
Keyword(s):  
Disease Risk ◽  
Coral Disease ◽  
Disease Outbreaks ◽  
Disease Outbreak ◽  
Host Size ◽  
Disease Spread ◽  
Wildlife Diseases ◽  
Infectious Individual ◽  
Force Of Infection ◽  
Affected Tissue

Understanding how disease risk varies over time and across heterogeneous populations is critical for managing disease outbreaks, but this information is rarely known for wildlife diseases. Here, we demonstrate that variation in host and pathogen factors drive the direction, duration and intensity of a coral disease outbreak. We collected longitudinal health data for 200 coral colonies, and found that disease risk increased with host size and severity of diseased neighbours, and disease spread was highest among individuals between 5 and 20 m apart. Disease risk increased by 2% with every 10 cm increase in host size. Healthy colonies with severely diseased neighbours (greater than 75% affected tissue) were 1.6 times more likely to develop disease signs compared with colonies with moderately diseased neighbours (25–75% affected tissue). Force of infection ranged from 7 to 20 disease cases per 1000 colonies (mean = 15 cases per 1000 colonies). The effective reproductive ratio, or average number of secondary infections per infectious individual, ranged from 0.16 to 1.22. Probability of transmission depended strongly on proximity to diseased neighbours, which demonstrates that marine disease spread can be highly constrained within patch reefs.

Abstract P125: The First Year of Pre-Hospital Triage for Emergent Large Vessel Stroke Across a Large New York City Health System

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brian D Kim ◽  
Jacob Morey ◽  
Naoum Fares Marayati ◽  
Danielle Wheelwright ◽  
Tara L Roche ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Los Angeles ◽  
Health System ◽  
York City ◽  
Large Vessel ◽  
Access Time ◽  
Hospital Arrival ◽  
Arterial Access ◽  
Triage Protocol

Introduction: On April 1 2019, New York City EMS began a triage protocol using a modified Los Angeles Motor Scale (S-LAMS for addition of speech) to identify potential endovascular thrombectomy (EVT) eligible patients in the field (S-LAMS 4-6 with last known well (LKW) <5 hours). These patients are routed to the nearest thrombectomy capable center, driving past potentially closer primary stroke centers. Methods: Patients brought by EMS to a large multicenter health system across NYC for the year following April 1, 2019 were extracted from a prospectively collected stroke database. S-LAMS triage positive (STP) patients were assessed for diagnostic accuracy and treatment times. They were compared with a cohort that underwent EVT during the same period, but triaged as S-LAMS triage negative (STN). Results: STP patients (N=145) were 56.6% women, mean age of 70, median baseline mRS of 0, S-LAMS score of 5, and arrival NIHSS of 13. Stroke was diagnosed in 110 (75.8%) patients, 32 intracerebral hemorrhage and 78 ischemic. Of the ischemic, 45 were large vessel occlusion stroke (ELVO) and 34 underwent EVT (PPV of 0.31 for ELVO). STN patients (N=65) with LKW of < 5 hours were brought by EMS and underwent EVT; 34 were brought directly to EVT capable centers, and 36 required transfer for EVT. Mean time to hospital arrival from EMS scene arrival was significantly longer for STP patients than STN patients (38 vs. 29 minutes, p<0.01). Mean ambulance travel time was significantly longer for STP patients than STN patients (10 vs. 7 minutes, p<0.01). Mean tPA administration time from EMS scene arrival was not significantly different between STP (N=41) and STN patients (N=40) (90 vs. 91 minutes, p=0.89). Mean arterial access time for EVT from EMS scene arrival was significantly shorter for STP patients than STN patients (137 vs. 200 minutes, p<0.01). Conclusions: Pre-hospital stroke triage using the streamlined S-LAMS scale is comparable with other pre-hospital scales in predictive value for ELVO. While pre-hospital evaluation and transport times are longer, they add minimal delay to the hospital arrival, do not affect tPA times, and improve times to EVT in a large, urban environment. Further analysis on effect of the triage protocol on patient outcomes is warranted.

Local Disasters, Government Actors, and National Policy

2020 ◽  
pp. 1-11
Author(s):  
Timothy W. Kneeland
Keyword(s):  
New York ◽  
Emergency Management ◽  
Federal Government ◽  
National Policy ◽  
The United States ◽  
Local Leadership ◽  
Disaster Policy ◽  
National Trends ◽  
Disaster Aid

This introductory chapter provides an overview of Hurricane Agnes, which swept through New York and Pennsylvania in late June of 1972. National trends influenced the federal and local response to the disaster. Hurricane Agnes struck the United States less than five months before the 1972 presidential election, and Richard Nixon's response to Hurricane Agnes was one variable in that election, which charted the course of American politics for the next three decades. In order to win reelection in 1972, President Nixon enacted the most substantial disaster aid package in history to that time, termed the Agnes Recovery Act, which he was convinced was the key to winning New York and Pennsylvania. The chapter then explains that local leaders played a crucial role in responding to the crisis in their communities and in flood recovery operations and rebuilding. Often neglected in studies of natural disaster policy is the way in which local leadership from government and the private sector interacted with representatives of the federal government to restore order and implement change. The chapter also introduces the Federal Office of Emergency Management (FEMA).

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