Assessing Hospital and Health System Preparedness and Response

1
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

2
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
• Lessons learned from field exercises and
  simulations
• 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?

3
Health Care SystemAt-Risk Clinical Areas

• Primary care
• Need for IT decision support systems for
  diagnosis and disease management
• Home care/long term care
• Long term impact of mass casualties on
  facilities, equipment and personnel
• Emergency Department
• Ability to adequately surge capacity for mass
  casualties
• Acute and Intensive care of critically ill
• Availability of ICU equipment and personnel

4
Health Services and Health System Research Needs

• 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
  
• 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
• Develop models (e.g., regional plans, prophylaxis
  and immunization systems), that work and can be
  exported to State and local areas

5
Using Health Systems Research to Address Key
Issues

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

6
Regionalization of Healthcare Services

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

7
Challenges Facing Rural Providers

• 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
• Lack of electronic connectivity and decision
  support tools for diagnosis and disease
  management of rare diseases

8
Downstream Benefits of Community Readiness for
Bioterrorism

• Long overdue redesign of systems, including ED
  and hospital systems of care
• Enhanced IT and decision support for front-line
  clinical providers
• 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