Temporal Variability in Diagnosis Code Distributions Across Extraction Time Points in a Multicenter Integrated EHR Database: A Snapshot Comparison Study.

Alternate care facilities (ACFs) are structures temporarily repurposed for health care delivery during public health emergencies to provide surge capacity for traditional health care institutions. ACFs have operated in convention centers, gymnasiums, and warehouses for purposes ranging from vaccination clinics to step-down and intensive care units. In the US, the Administration for Strategic Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) has published resources to guide ACF planning and operations. Many of these resources draw on expert opinion and published recommendations from civilian and military experts. The COVID-19 pandemic created demand for surge capacity, leading to increases in ACF implementation and publications highlighting operational challenges. Many publications concluded with suggested checklists and recommended policy changes, with limited reference to available resources. We used qualitative methods to analyze all-hazards ACF operational experiences, with a primary outcome of identifying successes, challenges, and best practices for ACF operations given the more recent increase in their utilization. Our secondary outcome included an assessment of gaps in existing guidance.