The Integration of Health Centers into
Community Emergency Preparedness
Planning: An Assessment of Linkages
Nicole V. Wineman MA, MPH, MBA
Barbara I. Braun PhD, Joseph Barbera MD,
Stephen P. Schmaltz PhD,
Jerod M. Loeb PhD
Division of Research
Joint Commission on Accreditation of Healthcare
Organizations
Funding Source: AHRQ Partnerships for Quality Initiative
(Cooperative Agreement Number 1-U18-HS13728-01)
Role of Health Centers
890 HRSA – Bureau of Primary Health
Care (BPHC) supported health centers
Part of nation’s health care safety net
Provide care to 15 million people across
5000 sites
Have been involved in providing primary
care services in many disasters
Study Objectives
Conduct a national baseline assessment
of health center integration into community
planning
Test whether better linkages were
associated with high perceived hazards,
experience responding to an event, and
health center characteristics
Design and Implementation
Expert panel assisted in questionnaire
development
Assessed linkages issues related to:
Experience with prior emergencies/disasters
Involvement in Community planning
Role in community response
Communication
Surveillance, reporting and lab testing
Training and exercises
Mailed questionnaire sent to population of BPHC
supported health centers in February 2005
Response
307 (34%) health centers responded
Responders included:
executives/administrators (54%)
medical/clinical staff (15%)
QI/compliance personnel (14%)
Responders vs Non-responders
Responders:
-Higher user volume than non-responders
-More likely to be JCAHO Accredited
(39%) than non-responders (28%)
-No difference in number of sites
Selected Findings
Collaborative Planning
54% of health centers are represented on
the community planning group
39% report that staff have seen the
community emergency operations plan
(EOP)
27% completed a collaborative HVA with
community responders
24% participated in community-wide drills
Selected Findings, continued
Collaborative Response
37% reported that the community used a
formal IMS, but 55% did not know
About half reported that the community
had established a role for their center in an
emergency
Only 30% reported that their role is
documented in the community plan
Selected Findings, continued
Experience in disaster response
30% responded to an actual disaster or public
health emergency, 11% to a potential/suspected
event
Most common event responses:
Provide medical care (48%)
Evacuate / Close (40%) Reassign staff (27%)
Provide education / information (21%)
Serve as communication liaison (21%)
Indicators of Strong Linkages
Health center has completed a collaborative
hazard and vulnerability analysis with
community responders
+
Health center role is documented in the
community emergency response plan
+
Health center has participated in communitywide drills.
_______________________________________
=
Strong linkages (summary indicator score)
Multivariate Analysis:
Significant associations between summary
linkages indicator score and questionnaire items
Questionnaire Item
HC staff have been involved in communitywide training
Odds Ratio
(95% CI)
3.61
(2.03 – 6.41)
HC EOP developed in collaboration with EMA
3.37
(1.92 - 5.90)
Community plan addresses HC’s need for
supplies and equipment during an event
3.01
(1.70 – 5.33)
HC staff have seen community EOP
2.95
(1.68 – 5.21)
p value of < .05 was used for inclusion
and retention in the model
Significant associations between summary
linkages indicator score and questionnaire
items, continued
Questionnaire Item
Odds Ratio
(95% CI)
HC representation at the local/county EOC
2.28
during a response
(1.21 – 4.30)
HC has a designated contact person that
2.27
can be reached by the community EMA 24/7 (1.20 – 4.30)
HC staff involved in community emergency
2.18
preparedness and response planning
(1.21 – 4.61)
p value of < .of was used for inclusion
and retention in the model
Health center characteristics not
associated with higher linkages score
Heath center experience responding to an
actual / potential disaster event
High perceived hazards or threats
Location within a MMRS region
High user volume
Large number of sites
Limitations
Possible response bias
No data on urban/rural location
Health center perspective only
No verification
Conclusions
Health centers are commonly on the
community planning group, but the
involvement may be superficial
Integration into substantive planning and
response activities is limited
Health center and community
characteristics were not associated with
linkages – there is another driving force
Implications
The importance of including health centers
in planning and response is overlooked
Community planners should be
encouraged to involve health centers
Collaborative planning can be effectively
efficiently achieved through a health care
coalition
Contact Information
Nicole Wineman, MA, MPH, MBA
Associate Project Director
Division of Research
Joint Commission on Accreditation of Healthcare Organizations
Phone: 630-792-5948
E-mail: nwineman@jcaho.org