The Integration of Health Centers into The Integration of Health Centers into Community Emergency Preparedness Community Emergency Preparedness Planning: An Assessment of LinkagesPlanning: An Assessment of Linkages

Nicole V. Wineman MA, MPH, MBANicole V. Wineman MA, MPH, MBA

Barbara I. Braun PhD, Joseph Barbera MD, Barbara I. Braun PhD, Joseph Barbera MD, Stephen P. Schmaltz PhD,Stephen P. Schmaltz PhD,

Jerod M. Loeb PhD Jerod M. Loeb PhD

Division of Research Division of Research Joint Commission on Accreditation of Healthcare Joint Commission on Accreditation of Healthcare

OrganizationsOrganizations

Funding Source: AHRQ Partnerships for Quality Initiative Funding Source: AHRQ Partnerships for Quality Initiative (Cooperative Agreement Number 1-U18-HS13728-01)(Cooperative Agreement Number 1-U18-HS13728-01)

Role of Health CentersRole of Health Centers

890 HRSA – Bureau of Primary Health 890 HRSA – Bureau of Primary Health Care (BPHC) supported health centersCare (BPHC) supported health centers

Part of nation’s health care safety net Part of nation’s health care safety net

Provide care to 15 million people across Provide care to 15 million people across 5000 sites5000 sites

Have been involved in providing primary Have been involved in providing primary care services in many disasterscare services in many disasters

Study ObjectivesStudy Objectives

Conduct a national baseline assessment Conduct a national baseline assessment of health center integration into community of health center integration into community planningplanning

Test whether better linkages were Test whether better linkages were associated with high perceived hazards, associated with high perceived hazards, experience responding to an event, and experience responding to an event, and health center characteristicshealth center characteristics

Design and ImplementationDesign and ImplementationExpert panel assisted in questionnaire Expert panel assisted in questionnaire developmentdevelopment

Assessed linkages issues related to:Assessed linkages issues related to:Experience with prior emergencies/disastersExperience with prior emergencies/disasters

Involvement in Community planningInvolvement in Community planningRole in community responseRole in community responseCommunicationCommunicationSurveillance, reporting and lab testingSurveillance, reporting and lab testingTraining and exercisesTraining and exercises

Mailed questionnaire sent to population of BPHC Mailed questionnaire sent to population of BPHC supported health centers in February 2005supported health centers in February 2005

ResponseResponse307 (34%) health centers responded307 (34%) health centers responded

Responders included:Responders included:executives/administrators (54%)executives/administrators (54%)medical/clinical staff (15%)medical/clinical staff (15%)QI/compliance personnel (14%)QI/compliance personnel (14%)

Responders vs Non-respondersResponders vs Non-respondersResponders:Responders: -Higher user volume than non-responders-Higher user volume than non-responders -More likely to be JCAHO Accredited -More likely to be JCAHO Accredited

(39%) than non-responders (28%) (39%) than non-responders (28%) -No difference in number of sites-No difference in number of sites

Selected FindingsSelected Findings

Collaborative PlanningCollaborative Planning

54% of health centers are represented on 54% of health centers are represented on the community planning groupthe community planning group

39% report that staff have seen the 39% report that staff have seen the community emergency operations plan community emergency operations plan (EOP)(EOP)

27% completed a collaborative HVA with 27% completed a collaborative HVA with community responderscommunity responders

24% participated in community-wide drills24% participated in community-wide drills

Selected Findings, continuedSelected Findings, continued

Collaborative ResponseCollaborative Response

37% reported that the community used a 37% reported that the community used a formal IMS, but 55% did not knowformal IMS, but 55% did not know

About half reported that the community About half reported that the community had established a role for their center in an had established a role for their center in an emergencyemergency

Only 30% reported that their role is Only 30% reported that their role is documented in the community plandocumented in the community plan

Experience in disaster responseExperience in disaster response

30% responded to an actual disaster or public 30% responded to an actual disaster or public health emergency, 11% to a health emergency, 11% to a potential/suspected eventpotential/suspected event

Most common event responses:Most common event responses:Provide medical care (48%)Provide medical care (48%)Evacuate / Close (40%) Reassign staff (27%)Evacuate / Close (40%) Reassign staff (27%)Provide education / information (21%)Provide education / information (21%)Serve as communication liaison (21%)Serve as communication liaison (21%)

Selected Findings, continuedSelected Findings, continued

Indicators of Strong LinkagesIndicators of Strong Linkages

Health center has completed a collaborative Health center has completed a collaborative hazard and vulnerability analysis with hazard and vulnerability analysis with

community responderscommunity responders

++ Health center role is documented in the Health center role is documented in the community community emergency response planemergency response plan

+ Health center has participated in community-+ Health center has participated in community- wide drills. wide drills.

______________________________________________________________________________ = Strong linkages (summary indicator score)= Strong linkages (summary indicator score)

p value of < .05 was used for inclusion ap value of < .05 was used for inclusion and retention in the modelnd retention in the model

Multivariate Analysis: Multivariate Analysis: Significant associations between summary Significant associations between summary

linkages indicator score and questionnaire itemslinkages indicator score and questionnaire items

Questionnaire ItemQuestionnaire Item Odds RatioOdds Ratio

(95% CI)(95% CI)

HC staff have been involved in community-HC staff have been involved in community-wide trainingwide training

3.61 3.61

(2.03 – 6.41)(2.03 – 6.41)

HC EOP developed in collaboration with EMAHC EOP developed in collaboration with EMA 3.37 3.37

(1.92 - 5.90)(1.92 - 5.90)

Community plan addresses HC’s need for Community plan addresses HC’s need for supplies and equipment during an eventsupplies and equipment during an event

3.01 3.01

(1.70 – 5.33)(1.70 – 5.33)

HC staff have seen community EOPHC staff have seen community EOP 2.95 2.95

(1.68 – 5.21)(1.68 – 5.21)

p value of < .of was used for inclusion ap value of < .of was used for inclusion and retention in the modelnd retention in the model

Significant associations between summary Significant associations between summary linkages indicator score and questionnaire linkages indicator score and questionnaire

items, continueditems, continued

Questionnaire ItemQuestionnaire Item Odds RatioOdds Ratio

(95% CI)(95% CI)

HC representation at the local/county EOC HC representation at the local/county EOC during a responseduring a response

2.28 2.28

(1.21 – 4.30)(1.21 – 4.30)

HC has a designated contact person that HC has a designated contact person that can be reached by the community EMA can be reached by the community EMA 24/724/7

2.27 2.27

(1.20 – 4.30)(1.20 – 4.30)

HC staff involved in community emergency HC staff involved in community emergency preparedness and response planningpreparedness and response planning

2.18 2.18

(1.21 – 4.61)(1.21 – 4.61)

Health center characteristics Health center characteristics not not associated with higher linkages scoreassociated with higher linkages score

Heath center experience responding to an Heath center experience responding to an actual / potential disaster eventactual / potential disaster event

High perceived hazards or threatsHigh perceived hazards or threats

Location within a MMRS regionLocation within a MMRS region

High user volumeHigh user volume

Large number of sitesLarge number of sites

LimitationsLimitations

Possible response biasPossible response bias

No data on urban/rural locationNo data on urban/rural location

Health center perspective onlyHealth center perspective only

No verificationNo verification

ConclusionsConclusions

Health centers are commonly on the Health centers are commonly on the community planning group, but the community planning group, but the involvement may be superficialinvolvement may be superficial

Integration into substantive planning and Integration into substantive planning and response activities is limitedresponse activities is limited

Health center and community Health center and community characteristics were not associated with characteristics were not associated with linkages – there is another driving linkages – there is another driving forceforce

ImplicationsImplications

The importance of including health centers The importance of including health centers in planning and response is overlookedin planning and response is overlooked

Community planners should be Community planners should be encouraged to involve health centersencouraged to involve health centers

Collaborative planning can be effectively Collaborative planning can be effectively efficiently achieved through a health care efficiently achieved through a health care coalitioncoalition

Contact InformationContact Information

Nicole Wineman, MA, MPH, MBANicole Wineman, MA, MPH, MBA

Associate Project DirectorAssociate Project Director

Division of ResearchDivision of Research

Joint Commission on Accreditation of Healthcare OrganizationsJoint Commission on Accreditation of Healthcare Organizations

Phone: 630-792-5948Phone: 630-792-5948

E-mail: nwineman@jcaho.orgE-mail: nwineman@jcaho.org