Using Medicare Data to Identify Individuals Who Are Electricity Dependent to Improve Disaster Preparedness and Response

摘要

During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we piloted a first-in-the-nation emergency preparedness drill in which we used Medicare claims data to identify individuals with electricity-dependent durable medical equipment during a disaster and securely disclosed it to a local health department. We found that Medicare claims data were 93% accurate in identifying individuals using a home oxygen concentrator or ventilator. The drill findings suggest that claims data can be useful in improving preparedness and response for electricity-dependent populations. Advances in health care delivery and an aging population have meant that increasing numbers of people with serious chronic conditions can live at home independently or with assistance. New technologies, including many types of life-sustaining durable medical equipment (DME), have facilitated this transition. Although many people with significant medical needs function well day to day, disasters, particularly those that cause power outages, can cause life-threatening situations that may lead them to seek care in the acute care setting, such as an emergency department or hospital. 1–3 Some may also seek care in shelters but, because of their special medical needs, may be turned away from commonly available general population shelters or placed in “special needs” shelters where they may become separated from their caregivers and loved ones. Others choose to shelter in their homes rather than seek help in hospitals or shelters, potentially endangering themselves. Recognition of this problem is not new. For example, during the historic 2003 blackout in New York City, Prezant et al. found that chronically ill patients with respiratory device failure were responsible for the greatest increase in health care utilization, accounting for 65 emergency department visits and 37 hospitalizations during the 48-hour postblackout period. 3 More recently, during Hurricane Isaac and Superstorm Sandy, multiple special needs shelters were established to assist these and other medically vulnerable populations. All required around-the-clock staffing by medical teams from the Medical Reserve Corps, local health departments, the US Public Health Service, or the National Disaster Medical System to ensure continuity of care. Local public health officials continue to report during informal postemergency debriefings that they do not have proactive and systematic ways to accurately identify those with special medical needs, including those who require electricity-dependent DME. Given the local health departments’ role in providing for those with special medical needs in a disaster, some communities and utility companies maintain registries for which individuals can self-register; however, their timeliness, completeness, and accuracy vary. There is broad acknowledgment that having information for populations with special medical needs would be useful for emergency planning and preparedness efforts, and could be life-saving during a prolonged power outage or disaster. 1,2,4–8 Medical claims data are a potential source of information for identifying individuals with life-sustaining medical equipment, either in advance of or after a disaster. However, the accuracy and usability of such information for this purpose is not thoroughly understood. To assess the accuracy of this information and its utility for a local public health response, we conducted a preparedness drill that used claims data from Medicare to identify individuals who required electricity-dependent respiratory DME.