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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: aram.dobalian@va.gov
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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 

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