Implementation of Florida Long Term Care Emergency Preparedness Portal Web Site, 2015–2017

Abstract

We built an online emergency preparedness Web site for Florida nursing homes after an earlier study revealed gaps in information and a lack of available preparedness resources for long-term care providers. The Long Term Care Emergency Preparedness Portal (www.ltcprepare.org) was launched in January 2015. We assessed its use and sought suggestions for improvement. Findings indicate that long-term care providers in Florida regularly use the Web site, and they welcome the opportunity to further leverage technology to aid their disaster planning.

More than 4 million people are admitted to or reside in nursing homes and skilled nursing facilities each year in the United States.¹ The patients served by these providers are fragile and have complex health conditions, which makes them vulnerable to disruptions in medical care, food, and shelter during disasters and emergencies. Many types of disasters require evacuation or shelter-in-place procedures, which are challenging for long-term care (LTC) providers and emergency management officials. As documented with large-scale disasters, such as Hurricanes Irma, Katrina, and Sandy, the lack of an efficient and effective system for communicating between LTC providers, patients, patients’ families, and emergency management officials may harm patients.^2–6

INTERVENTION

Previously, we assessed emergency preparedness capabilities and policies of LTC providers in California, Florida, and Georgia.⁷ Findings suggested that the level of preparedness varies widely across states and among nursing homes. In addition, we learned that although nursing homes conduct predisaster planning, they do so with little input from or coordination with public health or emergency management officials. Many nursing home administrators are also unaware of outside resources available to them during a disaster.

On the basis of this study, we created a Web portal to improve communication between LTC providers and their public health and emergency management partners. With the assistance of the Florida Health Care Association (FHCA) and Florida Department of Health, we designed the Florida Long Term Care Emergency Preparedness Portal (the Portal; www.ltcprepare.org). The Portal is a communications tool for building community and for sustaining an LTC emergency response system in Florida. It is organized by specific domains to provide users access to information related to national and state preparedness planning and response, emergency preparedness training, and disaster recovery. The Portal’s home page includes Twitter feeds from local and state public health and emergency preparedness agencies, and users can post questions to the site administrator, who will respond via e-mail within 48 hours.

PLACE AND TIME

The Portal was developed in 2014, launched in January 2015, and evaluated through December 2017.

PERSON

The targeted audiences for the Portal include LTC providers and administrators, and local and state public health and emergency management officials.

PURPOSE

The purpose of the intervention was to improve disaster preparedness among LTC providers by developing an online tool that strengthens communication and collaboration among the LTC, public health, and emergency management communities.

IMPLEMENTATION

We implemented the intervention in two phases: a predevelopment phase and an implementation and evaluation phase. In the predevelopment phase, we conducted key informant interviews with partners to assess their expectations, needs, and requirements for both the content and design of the Portal. We shared their recommendations with Web designers from our university technology development department, with whom we met regularly to review design drafts. These recommendations centered on design, functionality, and mobile technology use.

After a final draft of the Portal was created, the pilot testing and implementation phase began. During this phase, we shared the online tool with the FHCA, which agreed to host and maintain the Portal, and conducted several webinars to solicit additional feedback and provide technical assistance. As a last step in this pilot phase, we also developed an evaluation plan.

On January 15, 2015, the Portal was launched. The FHCA marketed the tool to its LTC providers and local and state emergency preparedness partners using several strategies, including press releases, e-mails, newsletter articles, announcements at state and local meetings, and the distribution of a postcard that presents a visual representation of the Portal (Figure A, available as a supplement to the online version of this article at http://www.ajph.org).

EVALUATION

We evaluated the implementation of the Portal using mixed methods, including Google Analytics, nursing home surveys, and telephone interviews with nursing home providers. This multimethod evaluation approach allowed us to follow the traffic of the Web site (via online analytics) while also collecting data from the intended audience (via interviews, surveys) about their knowledge of and preference for the Portal.

Google Analytics

We used Google Analytics to track Web site traffic. Figure 1 shows the total number of unique users or sessions on the Portal, from its launch in January 2015 through the end of December 2017. Web site traffic increased during hurricane season in both 2016 and 2017. Increased use of the Portal between fall 2016 and fall 2017 may be attributable to (1) the introduction of new LTC emergency preparedness regulations issued by the Centers for Medicare and Medicaid Services in September 2016, (2) use of the Portal to guide nursing homes’ implementation of these regulations, and (3) the occurrence of Hurricane Irma in September 2017.

FIGURE 1—

Florida Long Term Care Emergency Preparedness Portal Web Site Traffic Analytics: January 2015–December 2017

Note. CMS = Centers for Medicare and Medicaid Services.

Provider Surveys

In spring and summer 2017, we conducted an online survey of all 683 nursing homes in Florida to explore providers’ emergency preparedness activities and capabilities. The survey yielded a 42.2% response rate (288/683), and 83.0% were nursing home administrators (239/288). Findings indicate that of the 62.5% of respondents (180/288) familiar with the Portal, approximately 61.7% (111/180) used it at least monthly or occasionally. Almost three fourths of respondents familiar with the Portal rated it as a good resource for LTC emergency preparedness planning (129/180, or 71.7%). Open-ended survey responses indicated that the Portal has important information about emergency preparedness but could be refined to make it easier to find key resources.

Provider Interviews

To explore the survey findings in more detail, we conducted telephone interviews with nursing home providers who completed the online survey and indicated an interest in participating in a follow-up interview. A convenience sample of 11 interested participants (10 administrators, 1 environmental services manager) completed interviews, which explored the topics covered in the online survey as well as providers’ experiences with accessing LTC emergency preparedness resources, including Web sites and other electronic media. Informants also discussed their knowledge of the Portal and preferences for developing emergency preparedness resources for LTC providers. Three administrators were aware of the Portal and had used it to search for information related to disaster planning. One administrator explained, “It’s good. It [the Portal] gives you a good starting place for those that don’t have the proper information together. It gives different examples so you don’t have to start building it yourself.” One nursing home environmental services manager, who had not used the Portal but indicated an interest in using it, discussed the importance of using online tools for emergency preparedness planning, saying, “Technology is constantly increasing, and we need to stay on the cutting edge in the event of an emergency.”

SUSTAINABILITY

The Portal was developed through collaboration among our academic institution and key LTC and public health partners in Florida. Many providers are aware of and use the Portal to inform their emergency preparedness planning, and there appears to be support for maintaining it.

PUBLIC HEALTH SIGNIFICANCE

We developed an online emergency preparedness Web site for Florida nursing homes after previous research revealed gaps in information and a lack of available preparedness resources for LTC providers. The Portal serves as an interactive online tool that grants users immediate access to local, state, and national preparedness information. Implementation findings suggest that Florida nursing home providers have used this tool for their preparedness planning, particularly during times of large-scale emergencies, including Hurricane Irma.