Assessing Hospital and Health System Preparedness and Response Helen Burstin, M.D., M.P.H. Director Center for Primary Care Research Agency for Healthcare Research and Quality

Current State of Health Care System Preparedness October 2001: Anthrax event has prompted many systems to analyze real time responses and revise systems and plans October 2001: Anthrax event has prompted many systems to analyze real time responses and revise systems and plans Lessons learned from field exercises and simulations Lessons learned from field exercises and simulations States currently preparing regional plans to respond to HHS/HRSA funding States currently preparing regional plans to respond to HHS/HRSA funding Health services and health systems research to date: what do we know and need to know? Health services and health systems research to date: what do we know and need to know?

Health Care System: At-Risk Clinical Areas Primary care Primary care – Need for IT decision support systems for diagnosis and disease management Home care/long term care Home care/long term care – Long term impact of mass casualties on facilities, equipment and personnel Emergency Department Emergency Department – Ability to adequately surge capacity for mass casualties Acute and Intensive care of critically ill: Acute and Intensive care of critically ill: – Availability of ICU equipment and personnel

Health Services and Health System Research Needs Reinforce effective linkages between the health care system and the public health infrastructure Reinforce effective linkages between the health care system and the public health infrastructure Address issues of surge capacity, including outcomes and cost to hospitals and health systems Address issues of surge capacity, including outcomes and cost to hospitals and health systems Examine the impact of workforce and market forces on capacity and the effect of regional models of care Examine the impact of workforce and market forces on capacity and the effect of regional models of care Conduct and disseminate needs assessment data related to system capacity for a bioterrorist event Conduct and disseminate needs assessment data related to system capacity for a bioterrorist event Develop models (e.g., regional plans, prophylaxis and immunization systems), that work and can be exported to State and local areas Develop models (e.g., regional plans, prophylaxis and immunization systems), that work and can be exported to State and local areas

Using Health Systems Research to Address Key Issues n n Surge Capacity: – Facilities (ED, ICU, long term care, home care) – Equipment (vaccines, monitors, ventilators) – Personnel (nursing staff, EMS, cross-training) n Workforce Issues: – Best methods to train healthcare workforce – Deployment of adequately trained providers (e.g., mass prophylaxis and immunization) l Cross-training of the workforce l Use IT effectively to enhance provider readiness

Regionalization of Healthcare Services National Trauma Centers network National Trauma Centers network Organ Transplant regional models Organ Transplant regional models Cardiac Care models Cardiac Care models Department of Veteran Affairs and Department of Defense systems Department of Veteran Affairs and Department of Defense systems Need for more research Need for more research

Challenges Facing Rural Providers Distance and access to 24/7 public health infrastructure support, including epidemiologists and labs Distance and access to 24/7 public health infrastructure support, including epidemiologists and labs Limited community of providers for consultation and collaboration for response to a mass casualty event Limited community of providers for consultation and collaboration for response to a mass casualty event Lack of electronic connectivity and decision support tools for diagnosis and disease management of rare diseases Lack of electronic connectivity and decision support tools for diagnosis and disease management of rare diseases

Downstream Benefits of Community Readiness for Bioterrorism Long overdue redesign of systems, including ED and hospital systems of care Long overdue redesign of systems, including ED and hospital systems of care Enhanced IT and decision support for front- line clinical providers Enhanced IT and decision support for front- line clinical providers Enhanced electronic connectivity and communication between health care and public health systems Enhanced electronic connectivity and communication between health care and public health systems Established contacts and trust between providers/ public-private partnerships/ networks within local communities for improved patient care Established contacts and trust between providers/ public-private partnerships/ networks within local communities for improved patient care