3. An Alternative Method for Estimating the At-Risk Population

Given the difficulty of identifying data sources that contain the necessary level of detail, the investigators attempted to take a grassroots approach by going directly to one community (Worcester, Massachusetts) and asking local health care and social service providers to estimate the number of at-risk individuals. A global list of home health agencies, hospice care organizations, oxygen suppliers, home infusion providers, medical supply companies, substance abuse and methadone clinics, Meals on Wheels providers, and adult day care centers was compiled through an Internet search and the Department of Health and Human Services' Medicare Supplier Directory. These organizations were contacted by phone during May and June 2009. When an appropriate contact person was located, which was not possible in all cases, the contact was asked a list of questions related to emergency preparedness.

Table 18 shows the number of entities on the original contact list, the number of entities for which a contact person was found, and the number of entities that provided information about at least one of the questions, either by phone or E-mail. Although investigators were able to reach 87 percent of the original contacts, only slightly more than 25 percent were willing to share information, and of those only a handful could provide estimates of the number of clients/patients they considered to be in the highest risk category for hospitalization if services were disrupted during a disaster.

The home care agencies were better able to estimate the number of patients in the highest risk category; in contrast, only one oxygen supplier could provide an estimate of their patients at highest risk.

This attempt at gathering estimates from the "ground up" was labor intensive and did not appear to yield any better information than that available from the national surveys. The investigators were not completely confident that they had reached every possible supplier/provider in the area and found it took multiple attempts to establish contact with the entities identified. In some cases, the supplier/provider identified did not service the group of patients/clients pertinent to this study. Even when contact was made with an appropriate individual, some supplier/providers were not particularly forthcoming with information they may consider proprietary. For these reasons, local emergency planners are not likely to be able to estimate the at-risk population in this way.

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