How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response

2017 ◽  
Vol 11 (4) ◽  
pp. 467-472 ◽  
Author(s):  
Rebecca Lis ◽  
Vicki Sakata ◽  
Onora Lien
Keyword(s):  
Public Health ◽  
Health Care ◽  
Decision Making ◽  
Delphi Method ◽  
Disaster Response ◽  
Situational Awareness ◽  
State Level ◽  
Health State ◽  
State And Local ◽  
Data Elements

AbstractObjectiveTo identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency.MethodsA classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators.ResultsIn the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster.ConclusionsThe identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467–472)

Moving from situational awareness to decisions during disaster response: Transition to decision making

2013 ◽  
Vol 11 (6) ◽  
pp. 423 ◽  
Author(s):  
Jeffrey A. Glick, PhD ◽  
Joseph A. Barbera, MD
Keyword(s):  
Decision Making ◽  
Decision Maker ◽  
Disaster Response ◽  
Situational Awareness ◽  
Initial Response ◽  
Structured Interview ◽  
New Paradigm ◽  
Emergency Situations ◽  
Disaster Situation ◽  
Data Elements

During major disasters, at what point in the decisional process do senior government officials transition from developing necessary situational awareness to perform decision making? This “transition to decision making” (TDM) concept was analyzed through a structured interview survey of 25 current and former US Federal Coordinating Officers (FCOs) and focused on their decision-making process during the initial response period in a Presidentially declared Stafford Act disaster. This analysis suggests that the TDM for these emergency leaders is influenced by the following five factors: 1) Analogue Factor: the decision maker’s previous knowledge and experience from analogous disaster situations; 2) New Paradigm Factor: the degree to which the disaster situation is very atypical to the decision maker due to hazard type and/or situation severity, 3) Data Capture Factor: the quality, amount, and speed of disaster situation data conveyed to the decision maker; 4) Data Integration Factor: the decision maker’s ability to integrate situational data elements into a mental framework/picture; and 5) Time Urgency Factor: the decision maker’s perception as to time available before a decision has to be made. The article describes the factors and graphs that how these may influence the timing of the TDM in four types of emergency situations faced by FCOs: 1) an analogue disaster, 2) a disaster situation that presents a new paradigm, 3) an intuitive disaster situation, and 4) a disaster requiring an urgent response.

scholarly journals Crisis Decision-Making During Hurricane Sandy: An Analysis of Established and Emergent Disaster Response Behaviors in the New York Metro Area

2016 ◽  
Vol 10 (3) ◽  
pp. 436-442 ◽  
Author(s):  
Thomas Chandler ◽  
David M Abramson ◽  
Benita Panigrahi ◽  
Jeff Schlegelmilch ◽  
Noelle Frye
Keyword(s):  
Public Health ◽  
Decision Making ◽  
New York ◽  
Disaster Response ◽  
Situational Awareness ◽  
New York State ◽  
Hurricane Sandy ◽  
Health Staff ◽  
Health Departments ◽  
Public Health Staff

AbstractObjectiveThis collective case study examined how and why specific organizational decision-making processes transpired at 2 large suburban county health departments in lower New York State during their response to Hurricane Sandy in 2012. The study also examined the relationships that the agencies developed with other emerging and established organizations within their respective health systems.MethodsIn investigating these themes, the authors conducted in-depth, one-on-one interviews with 30 senior-level public health staff and first responders; reviewed documentation; and moderated 2 focus group discussions with 17 participants.ResultsAlthough a natural hazard such as a hurricane was not an unexpected event for these health departments, they nevertheless confronted a number of unforeseen challenges during the response phase: prolonged loss of power and fuel, limited situational awareness of the depth and breadth of the storm’s impact among disaster-exposed populations, and coordination problems with a number of organizations that emerged in response to the disaster.ConclusionsPublic health staff had few plans or protocols to guide them and often found themselves improvising and problem-solving with new organizations in the context of an overburdened health care system (Disaster Med Public Health Preparedness. 2016;10:436–442).

scholarly journals Patterns and correlates of mis-implementation in state chronic disease public health practice in the United States

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Margaret M. Padek ◽  
Stephanie Mazzucca ◽  
Peg Allen ◽  
Emily Rodriguez Weno ◽  
Edward Tsai ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Decision Making ◽  
Chronic Disease ◽  
Multinomial Logistic Regression ◽  
Public Health Practice ◽  
State Level ◽  
The United States ◽  
Organizational Level ◽  
Effective Programs

Abstract Background Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Methods A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman’s correlation and multinomial logistic regression were used to assess factors in mis-implementation. Results Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40). Conclusion The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.

ActionHealthNYC: Effectiveness of a Health Care Access Program for the Uninsured, 2016‒2017

2021 ◽  
pp. e1-e10
Author(s):  
Rishi K. Sood ◽  
Jin Yung Bae ◽  
Adrienne Sabety ◽  
Pui Ying Chan ◽  
Caroline Heindrichs
Keyword(s):  
Public Health ◽  
Health Care ◽  
New York ◽  
Health Care Access ◽  
Access To Health Care ◽  
Controlled Trial ◽  
The Past ◽  
Care Access ◽  
State And Local ◽  
Access Program

Objectives. To evaluate the effectiveness of a novel health care access program (ActionHealthNYC) for uninsured immigrants. Methods. The evaluation was conducted as a randomized controlled trial in New York City from May 2016 through June 2017. Using baseline and follow-up survey data, we assessed health care access, patient experience, and health status. Results.At baseline, 25% of participants had a regular source of care; two thirds had visited a doctor in the past year and reported 2.5 visits in the past 12 months, on average. Nine to 12 months later, intervention participants were 1.2 times more likely to report having a primary care provider (58% vs 46%), were 1.2 times more likely to have seen a doctor in the past 9 months (91% vs 77%), and had 1.5 times more health care visits (4.1 vs 2.9) compared with control participants. Conclusions. ActionHealthNYC increased health care access among program participants. Public Health Implications. State and local policymakers should build on the progress that has been made over the last decade to expand and improve access to health care for uninsured immigrants. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e10. https://doi.org/10.2105/AJPH.2021.306271 )

scholarly journals Patterns and Correlates of Mis-implementation in State Chronic Disease Public Health Practice in the United States

2021 ◽  
Author(s):  
Margaret Padek ◽  
Stephanie Mazzucca ◽  
Peg Allen ◽  
Emily Rodriguez Weno ◽  
Edward Tsai ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Decision Making ◽  
Chronic Disease ◽  
Multinomial Logistic Regression ◽  
Public Health Practice ◽  
State Level ◽  
The United States ◽  
Organizational Level ◽  
Effective Programs

Abstract Background: Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Methods: A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman’s correlation and multinomial logistic regression were used to assess factors in mis-implementation. Results: Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40). Conclusion: The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.

scholarly journals (A226) Establishing a Framework for Synchronizing Critical Decision Making with Information Analysis during a Health/Medical Emergency

2011 ◽  
Vol 26 (S1) ◽  
pp. s61-s61 ◽  
Author(s):  
J. Paturas ◽  
J. Pelazza ◽  
R. Smith
Keyword(s):  
Decision Making ◽  
Emergency Preparedness ◽  
Disaster Response ◽  
The United States ◽  
Medical Emergency ◽  
Incident Management ◽  
Local Health ◽  
Information Analysis ◽  
Incident Command ◽  
State And Local

BackgroundThe Yale New Haven Center for Emergency Preparedness and Disaster Response (YNH-CEPDR) has worked in the United States with state and local health and medical organizations to evaluate critical decision making activities and to develop decision making tools and protocols to enhance decision making in a time sensitive environment. YNH-CEPDR has also worked with international organizations and US federal agencies to support situational awareness activities in simulated and real world events.ObjectivesDuring this session YNH-CEPDR will share the best practices from recent events such as the H1N1 response and the Haiti Earthquake. Participants will be engaged in discussions regarding overall framework for successful information collection, analysis and dissemination to support decision making based on these experiences. This session will also incorporate concepts provided by the US National Incident Management System (NIMS) and the Incident Command System (ICS), specifically through the development of Situational Reports (SitReps), Incident Action Plans (IAP) and Job Action Sheets as methods to implement the framework and concepts discussed. Participants will be led through a series of scenario-based discussions to allow application of critical decision making factors to their organization. At the conclusion of the session, participants will be able to identify next steps for enhancing the synchronization of critical decision making and information analysis within their organizations.

Challenges of Designing and Implementing High Consequence Infectious Disease Response

2018 ◽  
Vol 12 (5) ◽  
pp. 563-566 ◽  
Author(s):  
Joan M. King ◽  
Chetan Tiwari ◽  
Armin R. Mikler ◽  
Martin O’Neill
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health Care ◽  
Spatial Configuration ◽  
The United States ◽  
Health Care Facilities ◽  
Disease Response ◽  
Response Planning ◽  
Care Facilities ◽  
State And Local

AbstractEbola is a high consequence infectious disease—a disease with the potential to cause outbreaks, epidemics, or pandemics with deadly possibilities, highly infectious, pathogenic, and virulent. Ebola’s first reported cases in the United States in September 2014 led to the development of preparedness capabilities for the mitigation of possible rapid outbreaks, with the Centers for Disease Control and Prevention (CDC) providing guidelines to assist public health officials in infectious disease response planning. These guidelines include broad goals for state and local agencies and detailed information concerning the types of resources needed at health care facilities. However, the spatial configuration of populations and existing health care facilities is neglected. An incomplete understanding of the demand landscape may result in an inefficient and inequitable allocation of resources to populations. Hence, this paper examines challenges in implementing CDC’s guidance for Ebola preparedness and mitigation in the context of geospatial allocation of health resources and discusses possible strategies for addressing such challenges. (Disaster Med Public Health Preparedness. 2018;12:563–566)

Toward a Centralized, Systematic Approach to the Identification, Appraisal, and Use of Health State Utility Values for Reimbursement Decision Making: Introducing the Health Utility Book (HUB)

2019 ◽  
Vol 39 (4) ◽  
pp. 371-379 ◽  
Author(s):  
Feng Xie ◽  
Michael Zoratti ◽  
Kelvin Chan ◽  
Don Husereau ◽  
Murray Krahn ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Cost Effectiveness ◽  
Systematic Approach ◽  
Health Utility ◽  
Reimbursement Decision ◽  
Health State ◽  
Life Years ◽  
Health State Utility Values

Cost-utility analysis (CUA) is a widely recommended form of health economic evaluation worldwide. The outcome measure in CUA is quality-adjusted life-years (QALYs), which are calculated using health state utility values (HSUVs) and corresponding life-years. Therefore, HSUVs play a significant role in determining cost-effectiveness. Formal adoption and endorsement of CUAs by reimbursement authorities motivates methodological advancement in HSUV measurement and application. A large body of evidence exploring various methods in measuring HSUVs has accumulated, imposing challenges for investigators in identifying and applying HSUVs to CUAs. First, large variations in HSUVs between studies are often reported, and these may lead to different cost-effectiveness conclusions. Second, issues concerning the quality of studies that generate HSUVs are increasingly highlighted in the literature. This issue is compounded by the limited published guidance and methodological standards for assessing the quality of these studies. Third, reimbursement decision making is a context-specific process. Therefore, while an HSUV study may be of high quality, it is not necessarily appropriate for use in all reimbursement jurisdictions. To address these issues, by promoting a systematic approach to study identification, critical appraisal, and appropriate use, we are developing the Health Utility Book (HUB). The HUB consists of an HSUV registry, a quality assessment tool for health utility studies, and a checklist for interpreting their use in CUAs. We anticipate that the HUB will make a timely and important contribution to the rigorous conduct and proper use of health utility studies for reimbursement decision making. In this way, health care resource allocation informed by HSUVs may reflect the preferences of the public, improve health outcomes of patients, and maintain the efficiency of health care systems.

An HL7-Aware Decision Support System for E-Health

2010 ◽  
pp. 670-683
Author(s):  
Pasquale De Meo
Keyword(s):  
Public Health ◽  
Health Care ◽  
Decision Making ◽  
Health Care Services ◽  
Public Health Care ◽  
Heterogeneous Information ◽  
Care Services ◽  
Health Level ◽  
Health Level Seven ◽  
Scientific Decision

In this chapter we present an information system conceived for supporting managers of Public Health Care Agencies to decide the new health care services to propose. Our system is HL7-aware; in fact, it uses the HL7 (Health Level Seven) standard (Health Level Seven [HL7], 2007) to effectively handle the interoperability among different Public Health Care Agencies. HL7 provides several functionalities for the exchange, the management and the integration of data concerning both patients and health care services. Our system appears particularly suited for supporting a rigorous and scientific decision making activity, taking a large variety of factors and a great amount of heterogeneous information into account.

The impact of correctional institutions on public health during a pandemic or emerging infection disaster

2008 ◽  
Vol 3 (3) ◽  
pp. 165 ◽  
Author(s):  
Rachel D. Schwartz, PhD
Keyword(s):  
Public Health ◽  
Disaster Response ◽  
Medical Community ◽  
Federal State ◽  
Correctional Facilities ◽  
Local Planning ◽  
Global Pandemic ◽  
Planning Processes ◽  
State And Local ◽  
The Impact

With the growing threat of a naturally occurring or man-made global pandemic, many public, private, federal, state, and local institutions have begun to develop some form of preparedness and response plans. Among those in the front lines of preparedness are hospitals and medical professionals who will be among the first responders in the event of such a disaster. At the other end of the spectrum of preparedness is the Corrections community who have been working in a relative vacuum, in part because of lack of funding, but also because they have been largely left out of state, federal local planning processes. This isolation and lack of support is compounded by negative public perceptions of correctional facilities and their inmates, and a failure to understand the serious impact a jail or prison facility would have on public health in the event of a disaster. This article examines the unique issues faced by correctional facilities responding to disease disasters and emphasizes the importance of assisting them to develop workable and effective preparedness and response plans that will prevent them from becoming disease repositories spreading illness and infection throughout our communities. To succeed in such planning, it is crucial that the public health and medical community be involved in correctional disaster planning and that they should integrate correctional disaster response with their own. Failure to do so endangers the health of the entire nation.

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