Changes in public health preparedness services provided to local health departments by regional offices in North Carolina: a comparison of two cross-sectional studies

Background: In 2011, seven decentralized Public Health Regional Surveillance Teams (PHRSTs) were restructured into four centralized Public Health Preparedness and Response (PHP&R) regional offices to realign preparedness priorities and essential services with appropriate infrastructure; field-based staff was reduced, saving approximately $1 million. The objective of this study was to understand the impact that restructuring had on services provided to local health departments (LHDs) throughout North Carolina. Methods: A survey to document services that regional offices provide to LHDs in North Carolina was administered by the North Carolina Preparedness and Emergency Response Research Center in 2013. The results were compared to a similar survey from 2009, which identified services provided by regional teams prior to restructuring. Results: Of 69 types of assistance, 14 (20%) were received by 50% or more LHDs in 2012. Compared to 2009, there was a significant decrease in the proportion of LHDs receiving 67% (n = 47) of services. The size of the region served by regional offices was shown to inversely impact the proportion of LHDs receiving services for 25% of services. There was a slight significant decline in perceived quality of the services provided by regional teams in 2012 as comparison to 2009. Conclusions: Following a system-wide review of preparedness in North Carolina, the state’s regional teams were reorganized to refine their focus to planning, exercises, and training. Some services, most notably under the functions of epidemiology and surveillance and public health event response, are now provided by other state offices. However, the study results indicate that several services that are still under the domain of the regional offices were received by fewer LHDs in 2012 than 2009. This decrease may be due to the larger number of counties now served by the four regional offices

Can Merging the Roles of Public Health Preparedness and Emergency Management Increase the Efficiency and Effectiveness of Emergency Planning and Response?

Some jurisdictions have reduced workforce and reallocated responsibilities for public health preparedness and emergency management to more efficiently use resources and improve planning and response. Key informant interviews were conducted in six counties in North Carolina (USA) to discuss perceptions of the challenges and opportunities provided by the new shared positions. Respondents feel that planning and response have improved, but that requirements related to activities or equipment that are eligible for funding (particularly on the public health side) can present an impediment to consolidating public health preparedness and emergency management roles. As the financial resources available for public health preparedness and emergency management continue to be reduced, the merging of the roles and responsibilities of public health preparedness and emergency management may present jurisdictions with an effective alternative to reducing staff, and potentially, readiness

Disaster impacts on cost and utilization of Medicare

Abstract Background To estimate changes in the cost and utilization of Medicare among beneficiaries over age 65 who have been impacted by a natural disaster, we merged publically available county-level Medicare claims for the years 2008–2012 with Federal Emergency Management Agency (FEMA) data related to disasters in each U.S. County from 2007 to 2012. Methods Fixed-effects generalized linear models were used to calculate change in per capita costs standardized by region and utilization per 1000 beneficiaries at the county level. Aggregate county demographic characteristics of Medicare participants were included as predictors of change in county-level utilization and cost. FEMA data was used to determine counties that experienced no, some, high, and extreme hazard exposure. FEMA data was merged with claims data to create a balanced panel dataset from 2008 to 2012. Results In general, both cost and utilization of Medicare services were higher in counties with more hazard exposure. However, utilization of home health services was lower in counties with more hazard exposure. Conclusions Additional research using individual-level data is needed to address limitations and determine the impacts of the substitution of services (e.g., inpatient rehabilitation for home health) that may be occurring in disaster affected areas during the post-disaster period

Institutional Facilitators and Barriers to Local Public Health Preparedness Planning for Vulnerable and At-Risk Populations

Numerous institutional facilitators and barriers to preparedness planning exist at the local level for vulnerable and at-risk populations. Findings of this evaluation study contribute to ongoing practice-based efforts to improve response services and address public health preparedness planning and training as they relate to vulnerable and at-risk populations

US Immigrants’ Experiences with the Covid-19 Pandemic- Findings from Online Focus Groups

Objective: Immigrants in the United States (US) are disproportionately affected by disasters. Yet the effects of one type of disaster—pandemics—have been underexplored in this regard. The purpose of this study was to better understand these effects, with specific attention to the impacts of the COVID-19 pandemic on US immigrants and their social networks. Design: Forty-five US immigrants (aged 18 and above) participated across eight online focus groups during spring 2020. Using “criterion of inclusion” sampling, participants were recruited via gatekeeper and snowball sampling methods. Anonymity was maintained throughout all online focus group sessions. Discussions were transcribed and then categorized into distinct code families for immigrants’ “experiences during pandemic” and “pandemic response activities.” The resultant human-categorized content was then qualitatively analyzed to explore the effects of COVID-19 on US immigrants. Results: COVID-19 posed unique challenges for immigrant communities in spring 2020. These challenges included added burdens of sending financial resources abroad, caring for dependent parents, and managing immigration status anxieties—alongside more commonplace challenges concerning childcare, employment, and interpersonal relationships. At the same time, US immigrants showed remarkable ability to leverage their experiences and social networks in response to COVID-19, so as to (1) provide pandemic-relevant health education within their communities, (2) provide targeted support to those in need (both in the US and in their home countries), and (3) draw upon past experiences in immigrants’ home countries when navigating the COVID-19 pandemic and the associated government lockdown in the US. Conclusions: US immigrants were significantly impacted by the COVID-19 pandemic. In addition to more broadly-imposed pandemic burdens related to concerns about childcare, employment, and interpersonal relationships, immigrant communities have faced unique challenges brought on by the pandemic. However, this study’s examination of pandemic experiences and response activities has illustrated that US immigrants’ unique backgrounds, cultures, and social networks have provided them with a number of notable resources and strategies for coping with the COVID-19 pandemic. These findings offer important insights into strategies that should be leveraged as part of planning and response to prevent the disparate impacts of current and future pandemics on immigrant populations

County-level hurricane exposure and birth rates: application of difference-in-differences analysis for confounding control

Abstract Background Epidemiological analyses of aggregated data are often used to evaluate theoretical health effects of natural disasters. Such analyses are susceptible to confounding by unmeasured differences between the exposed and unexposed populations. To demonstrate the difference-in-difference method our population included all recorded Florida live births that reached 20 weeks gestation and conceived after the first hurricane of 2004 or in 2003 (when no hurricanes made landfall). Hurricane exposure was categorized using ≥74 mile per hour hurricane wind speed as well as a 60 km spatial buffer based on weather data from the National Oceanic and Atmospheric Administration. The effect of exposure was quantified as live birth rate differences and 95 % confidence intervals [RD (95 % CI)]. To illustrate sensitivity of the results, the difference-in-differences estimates were compared to general linear models adjusted for census-level covariates. This analysis demonstrates difference-in-differences as a method to control for time-invariant confounders investigating hurricane exposure on live birth rates. Results Difference-in-differences analysis yielded consistently null associations across exposure metrics and hurricanes for the post hurricane rate difference between exposed and unexposed areas (e.g., Hurricane Ivan for 60 km spatial buffer [−0.02 births/1000 individuals (−0.51, 0.47)]. In contrast, general linear models suggested a positive association between hurricane exposure and birth rate [Hurricane Ivan for 60 km spatial buffer (2.80 births/1000 individuals (1.94, 3.67)] but not all models. Conclusions Ecological studies of associations between environmental exposures and health are susceptible to confounding due to unmeasured population attributes. Here we demonstrate an accessible method of control for time-invariant confounders for future research

Assessing Outcomes of Online Training in Public Health: Changes in Individual and Organizational Knowledge and Capacity

The need for a well-prepared public health workforce to prepare for and respond to threats of terrorism, infectious diseases, and other public health emergencies is well documented, as is the reality that the public health workforce in the United States is under-trained and unprepared to handle public health emergencies. The impact of training on the public health workforce is often measured by the volume of training completed and post-course evaluation data. A survey of current, high-volume users (n = 759) of the University of North Carolina Center for Public Health Preparedness Training Web Site, defined as individuals who had completed 12 or more training modules was conducted in order to determine if measurable changes in preparedness and response knowledge and capacity were brought about by the trainings. Two-hundred and seventy respondents completed the survey (response rate = 36%), with 52% reporting employment in governmental public health. Individual changes reported as a result of training included increased personal satisfaction (71%), increased job satisfaction (38%), and recognition by supervisors for training completion (23%); Organizational changes included updates to training plans (19%), making trainings mandatory (19%), and revising standard operating procedures (13%). Results from this survey indicate that the knowledge learned from completing online trainings led to changes in individuals and, to a lesser extent, changes in organizations

Community Health Needs Assessment in Wake County, North Carolina: Partnership of public health, hospitals, academia, and other stakeholders

Hospitals and other health care agencies are required to conduct a community health needs assessment (CHNA) every 3 years to obtain information about the health needs and concerns of the population. In 2013, to avoid duplication of efforts and to achieve a more comprehensive CHNA, Wake County Human Services, WakeMed Health and Hospitals, Duke Raleigh Hospital, Rex Healthcare, Wake Health Services, United Way of the Greater Triangle, and the North Carolina Institute for Public Health partnered to conduct a joint assessment for Wake County

Factors associated with risk of evacuation failure from Hurricane Isabel in North Carolina, 2003

Important differences in evacuation exist across households. This study describes associations between social factors and evacuation from Hurricane Isabel by residents of North Carolina in 2003. Census blocks in three affected counties were stratified by flood zone and 30 census blocks were selected probability proportionate to population size from each flood zone. Within selected blocks, 7 random interview locations were chosen using a geographic information systems-based site selection tool. Risk differences and 95% confidence intervals for evacuation were calculated. High levels of neighborhood social cohesion, markers of territoriality (e.g., no trespassing signs), membership in church or civic organization, volunteerism, neighbors’ evacuation, and longer length of residence were associated with reduced hurricane evacuation. Differential levels of social capital, social cohesion, and related social factors contributed to differential rates of evacuation from Hurricane Isabel. Those who reported closer relationships with neighbors and were active volunteers in the community may be more susceptible to evacuation failure and should receive targeted messages regarding evacuation from officials

Linking public health agencies and hospitals for improved emergency preparedness: North Carolina's public health epidemiologist program

<p>Abstract</p> <p>Background</p> <p>In 2003, 11 public health epidemiologists were placed in North Carolina's largest hospitals to enhance communication between public health agencies and healthcare systems for improved emergency preparedness. We describe the specific services public health epidemiologists provide to local health departments, the North Carolina Division of Public Health, and the hospitals in which they are based, and assess the value of these services to stakeholders.</p> <p>Methods</p> <p>We surveyed and/or interviewed public health epidemiologists, communicable disease nurses based at local health departments, North Carolina Division of Public Health staff, and public health epidemiologists' hospital supervisors to 1) elicit the services provided by public health epidemiologists in daily practice and during emergencies and 2) examine the value of these services. Interviews were transcribed and imported into ATLAS.ti for coding and analysis. Descriptive analyses were performed on quantitative survey data.</p> <p>Results</p> <p>Public health epidemiologists conduct syndromic surveillance of community-acquired infections and potential bioterrorism events, assist local health departments and the North Carolina Division of Public Health with public health investigations, educate clinicians on diseases of public health importance, and enhance communication between hospitals and public health agencies. Stakeholders place on a high value on the unique services provided by public health epidemiologists.</p> <p>Conclusions</p> <p>Public health epidemiologists effectively link public health agencies and hospitals to enhance syndromic surveillance, communicable disease management, and public health emergency preparedness and response. This comprehensive description of the program and its value to stakeholders, both in routine daily practice and in responding to a major public health emergency, can inform other states that may wish to establish a similar program as part of their larger public health emergency preparedness and response system.</p