Temporal Trends in Local Public Health Preparedness Capacity

Local health departments (LHDs) are essential to emergency preparedness and response activities. Since 2005, LHD resources for preparedness, including personnel, are declining in the face of continuing gaps and variation in the performance of preparedness activities. The effect of these funding decreases on LHD preparedness performance is not well understood. This study examines the performance of preparedness capacities among NC LHDs and a matched national comparison group of LHDs over three years. We observe significant decreases in five of eight preparedness domains from three years of survey data collected from 2010 through 2012. Most notably, we observe significant decreases in the Surveillance & Investigation domain. Performance decreases may be a result of continued, compounding declines in preparedness funding

Measuring Changes in Local Surveillance and Investigation Capacity

Background: The outbreak of Ebola virus disease in West Africa and confirmation of the first cases in the United States highlight the need for robust and responsive public health surveillance system. With a 25% decline in funding since 2007, the impact on local surveillance capacities has not previously been described. Purpose: The Surveillance & Investigation domain of the Local Health Department Preparedness Capacities Survey (PCAS) was reweighted to reflect the national profile of LHDs. Changes in subdomain performance of capacities and the effect of population size on subdomain capacity performance were examined over time. Methods: Participating LHDs (n=208) from the PCAS sample were reweighted according to characteristics from the 2010 National Association of County and City Health Officials (NACCHO) Profile. Overall changes in preparedness capacity across four subdomains from 2010 to 2012 were tested for significant differences using a weighted t-test. A series of weighted least squares regression models were used to determine whether population size may have modified the temporal changes in preparedness capacity. Results: Significant declines were observed in the preparedness capacity in three of the four subdomains of Surveillance & Investigation. Results suggest that surveillance inputs from various sources, including hospitals, urgent care, poison control, pharmacies, and schools absentee reporting, especially for larger LHDs, may be more sensitive to changes or shifts over time versus others. Implications: Declines in preparedness capacity may have affected the ability of LHDs, particularly larger ones, to effectively respond to community preparedness needs and, specifically, the detection of highly communicable and novel disease events

Effects of Performance Improvement Programs on Preparedness Capacities

In response to public health systems and services research priorities, we examined the extent to which participation in accreditation and performance improvement programs can be expected to enhance preparedness capacities

Measuring Changes in Local Surveillance and Investigation Capacity

Background: The outbreak of Ebola virus disease in West Africa and confirmation of the first cases in the United States highlight the need for robust and responsive public health surveillance system. With a 25% decline in funding since 2007, the impact on local surveillance capacities has not previously been described. Purpose: The Surveillance & Investigation domain of the Local Health Department Preparedness Capacities Survey (PCAS) was reweighted to reflect the national profile of LHDs. Changes in subdomain performance of capacities and the effect of population size on subdomain capacity performance were examined over time. Methods: Participating LHDs (n=208) from the PCAS sample were reweighted according to characteristics from the 2010 National Association of County and City Health Officials (NACCHO) Profile. Overall changes in preparedness capacity across four subdomains from 2010 to 2012 were tested for significant differences using a weighted t-test. A series of weighted least squares regression models were used to determine whether population size may have modified the temporal changes in preparedness capacity. Results: Significant declines were observed in the preparedness capacity in three of the four subdomains of Surveillance & Investigation. Results suggest that surveillance inputs from various sources, including hospitals, urgent care, poison control, pharmacies, and schools absentee reporting, especially for larger LHDs, may be more sensitive to changes or shifts over time versus others. Implications: Declines in preparedness capacity may have affected the ability of LHDs, particularly larger ones, to effectively respond to community preparedness needs and, specifically, the detection of highly communicable and novel disease events

Temporal Trends in Preparedness Capacity

Local health departments (LHDs) are essential to emergency preparedness and response activities. Since 2005, LHD resources for preparedness, including personnel, are declining in the face of continuing gaps and variation in the performance of preparedness activities. The effect of these funding decreases on LHD preparedness performance is not well understood. This study examines the performance of preparedness capacities among NC LHDs and a matched national comparison group of LHDs over three years. We observe significant decreases in five of eight preparedness domains from three years of survey data collected from 2010 through 2012. Most notably, we observe significant decreases in the Surveillance & Investigation domain. Performance decreases may be a result of continued, compounding declines in preparedness funding

Increasing Colorectal Cancer Testing: Translating Physician Interventions Into Population-Based Practice

Colorectal cancer (CRC) screening in the Medicare population remains low despite Medicare coverage. We describe a population-based effort to increase CRC testing of Medicare enrollees in two States through promotion and distribution of office-based tools to primary care physicians and gastroenterologists. Small increases in colonoscopy test use by primary care physicians were observed, but the differences were not statistically significant. Results in one State were stronger than the other, and two components of the intervention appeared more promising than others. Use of CRC tests can be increased, but additional approaches are needed

Quality Measures for Hospice and Palliative Care: Piloting the PEACE Measures

Background: The Carolinas Center for Medical Excellence launched the PEACE project in 2006, under contract with the Centers for Medicare & Medicaid Services (CMS), to identify, develop, and pilot test quality measures for hospice and palliative care programs

Use of Electronic Documentation for Quality Improvement in Hospice

Little evidence exists on the use of electronic documentation in hospice and its relationship to quality improvement practices. The purposes of this study were to: (1) estimate the prevalence of electronic documentation use in hospice; (2) identify organizational characteristics associated with use of electronic documentation; and (3) determine whether quality measurement practices differed based on documentation format (electronic vs. nonelectronic). Surveys concerning the use of electronic documentation for quality improvement practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of electronic documentation were able to monitor a wider range of quality-related data than users of nonelectronic documentation. Quality components such as advanced care planning, cultural needs, experience during care of the actively dying, and the number/types of care being delivered were more likely to be documented by users of electronic documentation. Use of electronic documentation may help hospices to monitor quality and compliance