Community Partnership Workshops for Delivery of Healthcare During an Influenza Pandemic

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Community Partnership Workshops for Delivery of
Healthcare During an Influenza Pandemic
Deborah Levy, PhD, MPH CAPT, USPHS Division of
Healthcare Quality Promotion Centers for Disease
Control and Prevention June 2, 2009
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Overview

• Introduction to HPA/DHQP/CDC
• Rationale for community workshops
• Pre-workshop planning
• Workshop activities
• Conclusion

The findings and conclusions in this presentation
are those of the author and do not necessarily
represent the views of the Centers for Disease
Control and Prevention/the Agency for Toxic
Substances and Disease Registry
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CDC/DHQPs Role in Pandemic Influenza Healthcare
Preparedness Planning

• Support HHS/ASPR lead for healthcare
  preparedness
• Coordinate with our federal partners to develop
  guidelines (e.g., AHRQ, DOT)
• Emphasize innovative strategies to empower local
  communities
• Include all components of the healthcare sector
• Develop tools based on local requests/needs
• Identify roadblocks to preparedness as grounds
  for future efforts

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Delivery of Care
Call Centers911 IRs
Pre-hospital
Hospitals
Homes
Community clinics refers to a spectrum of
outpatient/private provider, rural health
centers, urgent care centers, federally qualified
health centers (FQHC) and FQHC-like entities
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Why Do Communities Need to Prepare?

• The current healthcare system is already
  operating at surge capacity
• Traditional surge planning for an emergency based
  on HVA
• Local/regional
• Duration is hours, days, or weeks in length
• Often can turn to outside assistance (e.g., MOUs,
  MRCs, etc.)
• A pandemic scenario poses even more challenges
• Local/regional/national (90 million ill and 45
  million seeking out-patient care)
• Duration of response might be weeks to months
• Many communities will be affected at the same
  time

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What Benefit Does Preparing for Pandemic
Influenza Offer a Community?

• Pandemic planning is a learning process
• Improves awareness of a communitys resources and
  limitations
• Facilitates understanding of the day to day needs
  of a community
• Builds networks and relationships that can be
  utilized in multiple responses
• Planning together means more likely to be able to
  respond together in multiple types of emergencies

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H1N1 Situation as of 5/29/2009(data are
provisional)

• WHO pandemic phase 5
• US confirmed/probable cases
• 8975 cases, 578 hospitalized, 15 deaths
• US States including District of Columbia
• 49 with cases, 39 hospitalizations, 7 deaths
• International cases
• 13,398 confirmed cases in 48 countries

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H1N1 Emergency Room Situation
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Community Workshops for Healthcare Delivery in an
Influenza Pandemic

• Purpose
• Develop coordinated strategies for delivering
  healthcare to those at home, in the community,
  and up to and including the emergency room
• Identify preparedness needs related to healthcare
  delivery among community planners and other
  stakeholders
• Develop a Community Model of Healthcare
  Delivery for an influenza pandemic
• Community recruitment
• Issued Request for Participation (RFP) 10/07
• Engaged communities via telephone
• Four diverse communities selected as partners for
  2008 workshops

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Community Workshops for Healthcare Delivery in an
Influenza Pandemic

• 2008 Activities
• Models of Healthcare Delivery
• Mid-sized metropolitan area
• Multi-county rural region
• Development of an Alternative Care System
• Mid-sized metropolitan area
• 2009-2010 Activities
• Follow-up workshops planned for 2009/2010, large
  urban areas and alternate care system
• Continuing to develop tools/templates for
  community planners and other stakeholders

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Pre-Workshop Planning

• Established a community planning team
• Worked with ORISE and CDC to prepare agenda and
  activities
• Selected and invited workshop attendees
  representing each communitys healthcare response
  system
• Conducted needs assessment
• Identified in initial RFP and through
  teleconferences
• Reviewed pandemic influenza plans
• Completed the Community Assessment Tool

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Participating Sectors

• 911 and other call centers
• Emergency medical services
• Emergency departments
• Hospital administrators
• Primary care providers
• Urgent care centers and other outpatient clinics
• Home health
• Long term care
• Palliative care
• Pharmacists
• VA medical centers

• Public health
• Emergency management
• Local government
• Mortuary services
• Faith-based organizations
• Schools/school nurses
• Legal
• Public safety
• Non-profit organizations

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Pan Flu Scramble Activity

• Bring healthcare partners and supporting
  organizations to the same table
• Visualize surge in ill patients that will likely
  accompany a moderate to severe influenza pandemic
• Identify communitys issues and chokepoints
  associated with patient care

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Diagram of Healthcare Delivery Model

• From where do they receive patients?
• To where do they send patients?
• Where are the chokepoints in patient flow?
• What are the alternatives?
• At what points can they assist other critical
  sectors?

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Patient Gateways Activity

• Visualize the ways in which large numbers of ill
  patients are likely to enter the healthcare
  system during a moderate to severe influenza
  pandemic
• Provide opportunities for each healthcare sector
  to explain their capacities, plans for expansion,
  and plans for redirecting patient flow
• Strategize alternate routes of patient care to
  assist in developing a model of care diagram

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Resource Identification

• Identify and capture a list of resources from
  each sector
• Needed to respond during a pandemic
• Currently stockpiling
• Available to share with other sectors during an
  emergency
• Identify chokepoints associated with resource
  sharing and overlapping MOUs and MOAs

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Conclusions

• Entire process takes up to 12-18 months
• Participants reported significant improvements in
  knowledge about their communitys capability and
  capacity, and their level of preparedness
• Framework for effective community planning and
  preparedness requires core team that includes
  public health, healthcare, and emergency
  management

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Healthcare Preparedness Team

• CDC/DHQP
• Adeyelu Asekun
• Kelly Dickinson
• Kathy John
• Brian Kolodziejski
• Sherline Lee
• Melissa Morrison
• Jean Randolph
• Lewis Rubinson
• Alcia Williams

• ORISE
• Will Artley
• Ron Edmond
• Freddy Gray
• Linda Hodges
• Amber Miner
• Michael Outler
• Jennifer Reynolds
• Betsy Smither
• Casey Thomas
• Kelly Williams