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A Multi-State Survey on Public Health Emergency Preparedness
Paul Kuehnert, MS, RN Acting Deputy Director
Bureau of HealthMaine Department of Health and Human Services
Acknowledgements
Paul Campbell
Joshua Frances
Hugh Tilson
Harvard Ctr for Public Health Preparedness
The Maine PHEP Policy Research Group
RWJ Executive Nurse Fellows Program
Why Maine?
Maine is:• Large, poor rural state• No county or regional health departments• 2 municipal health departments• 39 private hospitals• Primary care shortage areas across state• EMS services largely volunteer staffed• No School of Public Health
Key Strategy: Collaboration
Multiple public and private partners in all strategic areas:– Maine Center for Public Health– Harvard Center for PHP– University of Southern Maine– State agency and private partners
Research
Who:– Maine Center for Public Health– Harvard Center for PHP– Office of Public Health Emergency Preparedness– Regional Resource Centers– University of Southern Maine
Why:– Increase our learning– Inform our policy decisions/advocacy– Share our successes and our challenges– Threat of redirection of funding from rural states
2004 Multi-State Survey
• Descriptive• Largely qualitative• Two questions:
– What are the current perceptions of state capacity for response to public health emergencies?
– What are the differences (if any) of perceptions of capacity for public health emergencies between rural and non-rural states?
Sample
• TFAH score used to select sample of states
• All states that fell into either the highest (scores of 6-7) or lowest (scores of 2-3) scoring groups of states (N=26)
• “Rural state” defined as > 25% of its population living outside of SMSAs as defined by the US Census Bureau (N=18)
Methods
• Phone and email-based semi-structured interview of state PHEP Directors
• 17 questions in each of 3 sections: 1. Current capacity --- Y/N Comments
2. Barriers --- Ranking 1 - 5 Comments
3. Enabling factors --- Ranking 1 – 5 Comments
Methods (cont’d)
• Questions grouped into 5 subject areas:
1. Public policy (4 questions)
2. Health care system (2 questions)
3. Public health system (4 questions)
4. Public health workforce (4 questions)
5. Connectivity (3 questions)
• Comments and explanations encouraged throughout the interview
Sample Questions
Do you have the following in your state:
• “ Current state (vs. solely federal) financial support for PHEP?” [Public policy]
• “Well-equipped and staffed hospital emergency rooms statewide? [Health care system]
• “Electronic communication system linking state and local public health departments 24/7 statewide? [Public health system]
Sample Questions (cont’d)
Does your state have:
4. “Strong training support in public health emergency preparedness from academic {preparedness} center?” [Public health workforce]
5. “Effective connectivity with other (non-PH) state bodies involved in emergency preparedness?” [Connectivity]
Results: Respondents
• 96% response rate (25/26 states)
• 17 Rural states, 8 Urban
• 3/17 (18%) of Rural states TFAH score > 6
• 5/8 (63%) of Urban states TFAH score > 6
• 6/8 (75%) Urban states received CRI funds
• 1/17 (6%) Rural states received CRI funds
11.1 13.1
01234567891011121314151617
Rural Urban
11.4
Results: Current Capacity Score
Results: Current Capacity
• Urban: more likely to describe health care and public health systems as strong
Results: Barriers
• All:– Lack of state general fund support– Status of regional/statewide health care system– Inadequately staffed/equipped ERs
• Urban:– Lack of local elected official support– Lack of support among legislators
• Rural:– Lack of strong local health departments – Lack of 24/7 electronic communications system linking state
and local health departments
Results: Enabling Factors• All:
– Training support from academic preparedness centers– Electronic communications systems 24/7 linking state
and local health departments
• Urban:– Strong local health departments statewide– Planning/evaluation framework using logic models– Graduate PH degree program in state– Well equipped/staffed ERs
• Rural:– Effective connectivity with other state agencies– Support of the Governor– Recent experience with a public health emergency
Summary: Rural-Urban Comparisons
• Political support: Strong local and state legislative support less likely in rural states
• Health care system: Adequate health care systems less common in rural states
• Public health system: Urban states more likely to have adequate public health infrastructure
• Public health workforce: Urban states more likely to have adequately trained workforce
• Connectivity: Rural states more likely to have strong working relationships with non-public health state agencies
Implications
• PHEP capacity still lags in most states
• Rural states face common challenges in building
PHEP capacity
• Further research needed to better describe rural
states’ needs and identify successful strategies
• Financial and human resources need to be targeted
to rural states
