Background: When continuity of routine, face-to-face care was disrupted during the 2017 and 2018 hurricane seasons, many VA clinicians used telehealth to provide virtual care. This study examines the use of VA telehealth services at the Houston VA Medical Center (VAMC) before and after Hurricane Harvey (8/25/2017), the first major hurricane to strike the U.S. since Superstorm Sandy (10/2012).

Methods: Using outpatient workload data from the VA Corporate Data Warehouse, a national repository of clinical and administrative data from all VA medical facilities, we extracted detailed information on each clinical visit for VA-users who accessed the Houston VAMC at least once during the 24 months prior to Harvey’s landfall.

Results: Thirty days before Harvey, an average of about 10% of all Houston VAMC outpatient visits every day were for telehealth services. However, telehealth use peaked at 42% at 6 days post-Harvey. There was a substantial increase in the following telehealth services: mental health, home non-video monitoring, home-based primary care and HUD-VASH, a program for homeless Veterans. In contrast, there was a modest decrease for primary care, triage, and ancillary services after Harvey.

Conclusion: During major crises such as natural disasters, the VA, which is the largest integrated healthcare delivery system in the US, has the capacity to transition from in-person care to telecare to ensure continued access to care for many health services. More research is needed to identify how telehealth can be used to minimize disruptions in access to care during major disasters, particularly for small and independent facilities.

Background: The Texas Gulf Coast was struck by Hurricane Ike in 2008 and Hurricane Harvey in 2017. While the public health impact of these events was widespread, little is known about their differential impact on patients scheduled for routine care encounters. Primary care resiliency is associated with better preventive care, which makes this important for healthcare systems to consider because of the increasing prevalence and severity of natural disasters.

Methods: Data were derived from the U.S. Department of Veterans Affairs (VA) Corporate Data Warehouse and included all appointments scheduled with VA primary care clinics for Houston and surrounding areas. The weekly percentage of missed primary care appointments (“resiliency”) for clinics in these areas was compared to others in the same administrative region, ranging from five weeks before to five weeks after the storms.

Results: For Hurricane Harvey, 14% of primary care appointments were kept the week of landfall (versus 33% for Ike), and 49% were kept the following week (versus 58% for Ike), suggesting a more widespread short-term impact on clinic operations relative to Ike. By the second week after both storms, the percentage of primary care appointments kept was approximately 60%. Unlike the more localized impact of Hurricane Ike, Hurricane Harvey impacted the resilience of clinics outside Houston, leading to lower appointment completion rates that were similar to the coastal regions.

Conclusions: Maintaining scheduled routine care reflects both within system preparedness and broader factors related to specific disasters, which influence measures of resilience and recovery.

Background: Following Hurricanes Irma and Maria (2017), there were major disruptions in health services in Puerto Rico with serious life-threatening consequences for dialysis patients. In this study, we examine use of dialysis services at San Juan VA Medical Center (VAMC) in Puerto Rico during and after these two hurricanes.

Methods: Using VA administrative/clinical data, we examined changes in use of maintenance hemodialysis care before, during, and after the two hurricanes between 8/6/2017 and 11/5/2017.

Results: 102 patients received outpatient hemodialysis at San Juan VAMC during the study period. 38 patients who were receiving dialysis at the VAMC exclusively had little interruption in their care because of the hurricanes, averaging 14, 13, and 12 visits per-month per-patient before, during, and after the hurricanes, respectively. 16 patients who were receiving limited or no dialysis from the VAMC before the hurricanes received all their dialysis care at the VAMC, averaging 10 visits during and after the hurricanes. 41 patients who received limited or no dialysis care at VAMC before the hurricanes received limited dialysis during and after the hurricanes, likely on emergency bases, and averaged one visit for all study periods. The remaining 7 patients did not receive any dialysis care at the VAMC after the hurricanes.

Conclusion: Following the hurricanes, in addition to providing dialysis services to their current patients, the San Juan VAMC dialysis unit expanded dialysis services to other VA patients who were not previously using the facility’s dialysis unit. Future studies should examine surge capacity limits for such facilities.

Background: There is limited understanding of how Home Based Primary Care (HBPC) programs support their medically complex patients during disasters. We aimed to identify emergency preparedness protocols and procedures undertaken in advance of the 2017 Hurricanes by staff of the Veterans Health Administration (VA) HBPC programs.

Methods: This mixed-methods study examined the activities of VA HBPC programs related to Hurricanes Harvey, Irma, and Maria. VA administrative and clinical data of nine impacted HBPC programs were analyzed to assess the number of HBPC visits and patients served pre-/post- Hurricane. Additionally, 35 phone interviews were conducted with program leaders and practitioners from these programs.

Results: Program patient census ranged from 45-540, with no reported loss of life due to the Hurricanes. Patient contacts immediately before and after the Hurricanes increased substantially. The programs implemented preparedness protocols well in advance of the Hurricanes and promptly tracked all patients after the events.

Conclusions: Demand for home health care such as VA’s HBPC program is projected to grow as the number of older adults increases. Emergency management efforts must likewise evolve to address the unique needs of these vulnerable patients in disasters in order to improve the community’s overall health resiliency to emergencies. Understanding the program activities conducted by these programs can help improve the understanding of how VA, and probably non-VA, home-based care programs can be best integrated into resilience planning of local communities. Future studies should examine other home health programs, particularly those that are not affiliated with large, integrated health systems.