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 11-U18U18-HS13728HS13728-01) 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 Response Role of Health Centers 890 HRSA – Bureau of Primary Health Care (BPHC) supported health centers Part of nation’ 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 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 Selected Findings 307 (34%) health centers responded Responders included: executives/administrators (54%) medical/clinical staff (15%) QI/compliance personnel (14%) Responders vs NonNon-responders Responders: -Higher user volume than nonnon-responders -More likely to be JCAHO Accredited (39%) than nonnon-responders (28%) -No difference in number of sites Copyright 2006 - Joint Commission 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 communitycommunity-wide drills 1 Selected Findings, continued Selected Findings, continued Experience in disaster response 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 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 communitycommunitywide drills. _______________________________________ = 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%) Multivariate Analysis: Significant associations between summary linkages indicator score and questionnaire items Questionnaire Item HC staff have been involved in communitycommunitywide 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’ 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) Strong linkages (summary indicator score) 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 HC representation at the local/county EOC during a response HC has a designated contact person that can be reached by the community EMA 24/7 HC staff involved in community emergency preparedness and response planning Health center characteristics not associated with higher linkages score Odds Ratio (95% CI) 2.28 (1.21 – 4.30) 2.27 (1.20 – 4.30) Heath center experience responding to an actual / potential disaster event 2.18 (1.21 – 4.61) High user volume High perceived hazards or threats Location within a MMRS region Large number of sites p value of < .of was used for inclusion and retention in the model Copyright 2006 - Joint Commission 2 Limitations Possible response bias No data on urban/rural location Health center perspective only No verification 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 Copyright 2006 - Joint Commission 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 Contact Information Nicole Wineman, MA, MPH, MBA Associate Project Director Division of Research Joint Commission on Accreditation of Healthcare Organizations Phone: 630630-792792-5948 E-mail: nwineman@jcaho.org 3