Providing Medical Care Before Sandy Struck Saved Lives, Report Finds

Andrew Kitchenman | July 6, 2015 | Health Care
Feds will use results of dialysis study in preparing emergency healthcare plans for future disasters, point to benefits of using Medicare data

Sandy flood
When Hurricane Sandy was bearing down on the Jersey Shore, some patients with advanced kidney disease received their dialysis treatments earlier than scheduled.

And that probably saved lives, a new study shows.

The federal government studied Medicare data from all patients with end-stage renal disease in New Jersey and New York City, comparing those who received early dialysis with those who didn’t.

Those who received the advance treatment were 20 percent less likely to end up in a hospital emergency room, 21 percent less likely to be hospitalized, and were 28 percent less likely to die within 30 days.

The U.S. Department of Health and Human Services will use the study published recently in the American Journal of Kidney Diseases to help medical providers and patients prepare for disasters across the country.

The study also points to the potential benefits of using the vast quantity of data compiled by the Centers for Medicare and Medicaid Services to improve the quality of care that patients receive.

The storm delayed some patients’ dialysis treatments, contributing to a rise in emergency room visits due to the storm — prompting medical experts to dub it a “kidney failure disaster.”

Patients with end-stage kidney disease require multiple dialysis sessions each week. Therefore, any disaster that disrupts dialysis can lead to deaths.

The study is part of a growing movement among researchers to use scientific evidence to help prepare for disasters. The data serves as a reminder, the study says, that providers should reach out to patients when an emergency occurs, that dialysis patients should be prepared for possible emergency closures of the facilities where they receive dialysis, and that those patients should know to bring their treatment plan to an alternate site or – if necessary – a hospital emergency room.

Dr. Nicole Lurie, U.S. assistant secretary for preparedness, served as one of the study’s authors.

“This study provides the first evidence that receiving early dialysis in advance of potential disasters helps protect health and saves lives for dialysis patients and suggests that early dialysis should become a standard practice and protective measure,” Lurie said in a statement.

The study used Medicare fee-for-service data for 13,836 dialysis patients, with the information that could personally identify them removed. It found that before the storm made landfall in New Jersey, 60 percent of end-stage renal disease patients received early treatment. Of the facilities that provided dialysis in the affected area, 70 percent provided early treatment.

Lurie and the other study authors recommended that facilities that provide dialysis conduct disaster drills to test their emergency and communications plans and to prepare for early dialysis treatments. Such a drill could also help a facility understand whether patients know how to use emergency changes in their diets to manage delays in treatments, the report said.

Dr. Joseph Vassalotti, chief medical officer of the National Kidney Foundation, said in a statement that the study “reflects another step forward to improve the education and training of patients and dialysis clinic staff, following the widely recognized poor response to Hurricane Katrina in August 2005.”

Another study in the American Journal of Kidney Diseases, published in July 2013, found that 306 dialysis facilities were closed during Sandy’s peak, on October 30, 2012. While the vast majority of these closures were planned, 19 remained closed the following day due to structural damage or power outages, while four centers remained closed for three days after the peak of the storm.

In addition to the studies on kidney disease, other studies have examined different Sandy-related health consequences in New Jersey.

For example, a two-year study found that seniors had an elevated risk for acute mental-health and other behavioral issues. This information was then used to target treatments toward those affected by the storm.

The research by Healthcare Quality Strategies Inc. found that few residents at risk of mental-health problems had been screened for these issues before the storm struck.