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The Puerto Rico Healthcare System Before and After Three Public Health Disasters

Award Number: R01MD016426
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 05/23/2022
PERIOD OF PERFORMANCE END DATE: 02/28/2026

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The Puerto Rico Healthcare System Before and After Three Public Health Disasters - PROJECT SUMMARY/ABSTRACT Intense natural disasters including hurricanes, floods, and earthquakes have become more frequent and closely spaced in recent years. Large scale natural disasters can severely damage and degrade health care facility structural integrity and equipment, create environmental hazards, and negatively affect health service delivery (e.g., cancelled surgeries; postponed preventive care; pharmacy closures; staffing, medication, and medical supply shortages; large transient surges in emergency department volume) – all of which contribute to increased stress among health care providers. Superimposing infectious disease epidemics on the natural disasters further exacerbates stress on the health care system. Over the span of 3 years, Puerto Rico suffered from 3 major back-to-back public health emergencies including 2 natural disasters and a pandemic. First, Hurricane Maria hit in September 2017 causing major devastation throughout the island. Communities lost access to essential services such as electricity, potable water, safe roads and bridges, and health care. Most of the island’s public and private health care facilities closed or had limited capacity for months. Second, in December 2019, a series of more than 500 quakes of magnitude 2.0 or greater struck Puerto Rico causing more infrastructure damage to many struggling health facilities and leaving thousands homeless or living outside in their yards. Third, Puerto Rico continues to deal with the novel coronavirus-19 (COVID-19) pandemic. This study will provide a unique opportunity to understand the effects of 3 distinct public health emergencies on a minority population with significant health and health care disparities. We have designed a mixed methods, multi-level study that will triangulate quantitative and qualitative data to study the pre and post effects of the 3 public health emergencies on Puerto Rico’s health care system’s preparedness, response, and recovery efforts and how the emergencies have affected the resiliency, experiences, and utilization of the island’s health care system. The study will use administrative utilization data from 50 general hospitals and 20 federally funded health centers on the island, qualitative interviews of health system leaders and providers, and follow-up interviews of a representative cohort of 3,062 island adult residents. Using the Donabedian quality of care model and concepts from an emerging literature on health system resilience as our study framework, we will 1) identify factors that influenced the capacity of Puerto Rico’s health care system to prepare for, respond to, and recover from Hurricane Maria, the earthquakes, and COVID-19, 2) model the cumulative effects of multiple disasters on health system resiliency and how these effects interact, and 3) elicit lessons learned from health care leaders and providers. We will synthesize the information from our triangulated research approach to provide data driven recommendations for an effective and coordinated approach to mitigation, preparedness, response, and resiliency under conditions of increasing frequency and intensity of disasters.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $570,454 )
2025	2025	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	008	4	5/27/2025	NON-COMPETING CONTINUATION	$0
2025	2025	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	005	4	2/20/2025	NON-COMPETING CONTINUATION	$570,454
2025	2024	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	006	3	4/18/2025	SUPPLEMENT FOR EXPANSION	$0
2025	2024	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	004	3	1/15/2025	SUPPLEMENT FOR EXPANSION	$0
2025	2024	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	007	3	5/16/2025	SUPPLEMENT FOR EXPANSION	$0
2025	2024	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	003	3	1/15/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2025	2024	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	002	3	10/16/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$745,120
2025	2023	DREXEL UNIVERSITY	3141 CHESTNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Minority Health and Health Disparities Research	001	2	10/16/2024	NON-COMPETING CONTINUATION	-$634,435
2025	2022	DREXEL UNIVERSITY	3141 CHESTNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Minority Health and Health Disparities Research	000	1	10/16/2024	NEW	-$110,685
														Subtotal = $570,454

Issue Date FY: 2024 ( Subtotal = $740,621 )
2024	2024	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	002	3	3/12/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2024	2024	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	003	3	6/13/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$46,772
2024	2024	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	004	3	9/25/2024	SUPPLEMENT FOR EXPANSION	$92,489
2024	2024	UNIVERSITY OF HAWAII	2425 CAMPUS RD SINCLAIR RM 1	HONOLULU	HI	96822	HONOLULU	USA	Minority Health and Health Disparities Research	001	3	3/1/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$601,360
2024	2023	DREXEL UNIVERSITY	3141 CHESTNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Minority Health and Health Disparities Research	000	2	3/1/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $740,621

Issue Date FY: 2023 ( Subtotal = $634,435 )
2023	2023	DREXEL UNIVERSITY	3141 CHESTNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Minority Health and Health Disparities Research	001	2	2/18/2023	NON-COMPETING CONTINUATION	$634,435
2023	2022	DREXEL UNIVERSITY	3141 CHESTNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Minority Health and Health Disparities Research	000	1	1/11/2023	NEW	$0
														Subtotal = $634,435

Issue Date FY: 2022 ( Subtotal = $652,956 )
2022	2022	DREXEL UNIVERSITY	3141 CHESTNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Minority Health and Health Disparities Research	000	1	5/23/2022	NEW	$652,956
														Subtotal = $652,956

Grand Total All Awards = $2,598,466

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The Puerto Rico Healthcare System Before and After Three Public Health Disasters

Award Number: R01MD016426

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 05/23/2022

PERIOD OF PERFORMANCE END DATE: 02/28/2026

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