AHRQ Annual Highlights, 2009 (continued)
Health Information Technology Portfolio
Since its inception in 2004, AHRQ's Health IT Portfolio has invested over $300 million in developing and disseminating evidence and evidence-based tools about health IT's impact on the quality, safety, efficiency, and effectiveness of health care. In FY09, the program invested $44.8 million in contracts and grants toward developing and disseminating evidence and evidence-based tools about the use of health IT in three main strategic focus areas:
- To improve health care decisionmaking.
- To improve the quality and safety of medication management.
- To support patient-centered care, the coordination of care across transitions, and the use of electronic exchange of health information.
With the enactment of the American Recovery and Reinvestment Act in 2009, the role of health IT in improving the quality of the Nation's health dramatically changed. As the provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act were developed and implemented, AHRQ's health IT initiative and research products have consistently anticipated the needs of the Nation to understand how health IT can improve quality:
- Since 2004, AHRQ has supported multiple State-wide health information exchange research projects and demonstrations, which have established the foundations for the HITECH State Health Information Exchange program.
- E-prescribing is a key component of meaningful use, and AHRQ's programmatic work as well as our extended collaboration with CMS have established new standards, best practices, and implementation tools that are being used to support this key requirement.
- A particularly thorny issue has been e-prescribing of controlled substances. An AHRQ-funded grant to the Massachusetts Department of Public Health has significantly contributed to a regulatory solution for this issue.
- AHRQ-funded work such as the reports of the National Quality Forum's Health IT Expert Panel and research projects at the American Medical Association's Physician Consortium for Performance Improvement, have helped improve the Nation's knowledge on how to better utilize health IT systems to measure quality health care in meaningful ways.
- Safety is a key component of healthcare quality, and AHRQ's initiative is helping make the Nation safer through tools such as the Computerized Provider Order Entry evaluation tool, currently used by the Leapfrog group to accredit the safest hospitals in America.
- AHRQ's National Resource Center for Health Information Technology in partnership with the Office of the National Coordinator for Health IT has begun implementation of the Health IT Research Center, a key component of the HITECH Extension program.
- AHRQ funded experts are abundantly represented in the growing staff of the Office of the National Coordinator, the Health IT Policy Committee, and the Health IT Standards Committee, emphasizing AHRQ's key role in preparing the field to address the challenges of HITECH implementation.
It has been highly rewarding to see the fruits of many years of investment and labor to support successful implementation, and the program now looks forward to meeting the challenges of answering the questions of the future that will be created by the significant investments of the HITECH Act.
In FY09, some key activities that the AHRQ Health IT Portfolio continued to support include:
- Research grants exploring the impact of health IT on quality in the ambulatory setting.
- Research grants focused on management of complex patients and the program's three strategic focus areas: improved decisionmaking, medication management, and patient-centered care.
- A contract to develop an electronic format for quality measurement and a draft quality data set to facilitate quality measurement.
- Contracts to demonstrate the translation and incorporation of care guidelines into commercial electronic health record (EHR) systems.
- Development and dissemination of an EHR implementation toolkit and other "how to" resources to assist health care organizations.
- Contracts to demonstrate health information exchange (HIE) in six States.
Improving Health Care Decisionmaking, Medication Management, and Patient-Centered Care
In support of its strategic focus area on improving health care decisionmaking, medication management, and patient-centered care, the AHRQ Health IT Portfolio produced the following publications:
- The Ambulatory Computerized Provider Order Entry report summarizes key findings from researchers who have implemented ambulatory computerized provider order entry and clinical decision support (CDS) tools in outpatient practices. CDS capabilities integrated within ambulatory EHRs and order entry systems provide clinicians with real-time support on a range of information related to diagnosis and treatment. They also provide tools aimed at improving patient care and reducing medical errors and costs. In addition, decision support may add rules to check for drug-drug interactions, allergies, medication contraindications, and renal and weight-based dosing, further enhancing the ability to reduce medical errors. The new report features lessons learned from health IT grantees about leadership, implementation and training, clinician adoption, and post-implementation considerations.
- Barcode Medication Administration: Emerging Lessons Learned is a report focusing on technologies used to reduce medication dispensing errors and improve patient safety in hospital settings. It discusses grants in AHRQ's Health IT Portfolio that are implementing or evaluating barcoding technologies to improve care for patients, increase efficiency, and contain costs, as well as the challenges faced by grantees in developing, implementing, or evaluating barcoding interventions.
- Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically Ill, and Underserved is an evidence review showing that there are distinct factors that influence the use and usability of interactive consumer health IT by the elderly, chronically ill, and underserved populations. The most common factor influencing the successful use of the interactive technology by these specific populations was that the consumers perceived a benefit from using the system.
- Chronic Disease Management is a report that focuses on technologies that support better management of chronic illnesses, such as diabetes and heart failure. It presents a snapshot of activities and the challenges that researchers faced during the development, implementation, or evaluation of a health IT intervention.
- Using Telehealth to Improve Quality and Safety, a report based on AHRQ-funded implementation projects, provides an overview of technical and organizational challenges faced by AHRQ health IT researchers when developing, implementing, or evaluating telehealth interventions. The telehealth projects fall into the following four areas: provider-to-provider communication with patients present, provider-to-provider communication without patients present, telemonitoring, and health education.
In addition, the Health IT Portfolio produced an evidence-based tool, the Pediatric Rules and Reminders, that provides pediatricians and other clinicians with the information needed to develop and implement specific rules and reminders into an EHR system for pediatric patients. These rules and reminders are designed to help providers who use EHRs to improve adherence to clinical guidelines.
National Resource Center for Health Information Technology
As part of the health IT initiative, AHRQ created the AHRQ National Resource Center for Health Information Technology (NRC) to help the health care community make the leap into the Information Age. In addition to providing technical assistance to the health IT research community, the NRC shares new knowledge and findings that have the potential to transform everyday clinical practice. The AHRQ NRC is committed to advancing our national goal of modernizing health care through the best and most effective use of health IT by serving as the main vehicle for disseminating program information and findings to its key audiences. In FY09, the NRC reached record levels of use (both unique users and resource downloads) and the Office of the National Coordinator for Health IT joined the Health Resources and Services Administration (HRSA) as a new Federal "customer" leveraging the NRC Web infrastructure.
In FY09, the Health IT Portfolio, together with the NRC, added, updated, or continued support for a key set of products focused on applying lessons learned from AHRQ research activities to improve the successful adoption, evaluation, and meaningful use of health IT and HIE activities. These products include:
- The Health IT Adoption Toolbox contains a range of resources relevant to the various stages of considering, planning, executing, and evaluating the implementation of health IT. The resources have been compiled from a number of public initiatives as well as resources explicitly created by HRSA. The toolbox is designed to meet the needs of a broad range of providers.
- The Accessible Health Information Technology (IT) for Populations with Limited Literacy: A Guide for Developers and Purchasers of Health IT (updated: June FY09) provides health IT developers with structure, strategies, and other resources for the development of health IT technologies for populations with limited literacy.
- Health IT Survey Compendium is a searchable resource containing a set of publicly available surveys to assist organizations in evaluating health IT. The surveys in the compendium cover a broad spectrum, including user satisfaction, usability, technology use, product functionality, and the impact of health IT on safety, quality, and efficiency.
- Health IT Bibliography puts expert-selected knowledge resources on health IT at the fingertips of those seeking to better understand how health IT can transform everyday care by improving its quality, safety, efficiency, and effectiveness.
- Health IT Evaluation Toolkit provides guidance on how to evaluate health IT. Examples of measures relevant to quality, safety, and efficiency are provided along with suggested data sources and the relative costs to collect the measures.
- Health IT Costs and Benefits Database Project is a searchable database containing the results of a literature search on the relative costs and benefits of health IT.
- The Health Information Privacy and Security Collaboration Toolkit provides guidance for conducting organization-level assessments of business practices, policies, and State laws that govern the privacy and security of health information exchange (HIE).
- HIE Evaluation Toolkit provides guidance on how to evaluate health information exchange.
- The Time and Motion Database enables organizations to measure the impact of health IT systems on clinical workflow through the collection of time-motion study data.
The initial contract for the NRC concluded at the end of the FY08. In FY09, the AHRQ Health IT Portfolio competed and awarded a series of master task orders, and a first round of tasks for the next generation of the NRC were assigned.
Health IT's First Annual Report
This inaugural report, Summary of AHRQ Health Information Technology Portfolio-Funded Projects as of 2008, features:
- A summary of activities in the Health IT Portfolio as of 2008.
- Details on how information generated through the Health IT Portfolio is disseminated.
- A description of the content of the project-specific summaries.
- Project summaries of 124 grant-specific and 26 contract-specific AHRQ-managed health projects.
For more information on AHRQ's Health IT Portfolio as well as its initiatives, reports, tools, and products, see http://healthit.ahrq.gov.
Recent Research Findings from the Health IT Portfolio
- A study of hospitals that care for children found that hospitals that became early adopters of computerized physician order entry (CPOE) had certain characteristics. Researchers analyzed hospital characteristics from 119 hospitals that care for children that used CPOE in 2003, including hospital type, bed size, ownership, health system affiliation, rural/urban location, and U.S. region. Dedicated children's hospitals were six times more likely to be early adopters of CPOE compared with general hospitals with pediatric units. Private for-profit hospitals were 26.5 times more likely than public hospitals to use CPOE, and urban teaching hospitals were nearly four times more likely than rural hospitals to use CPOE. Hospitals located in the Northeast, Midwest, and the South were 11.2, 4.2, and 3.1 times respectively more likely to use CPOE than hospitals located out West. (Clinical Pediatrics, May 2009)
- When implementing a clinical information system (CIS), institutions often provide extra training to employees who then serve as trainers, provide technical support, and champion the use of the system. Such individuals are called "super users." A new study found that the attitudes and time spent by these super users go a long way toward increasing positive employee perceptions of the CIS. Researchers found that more hours devoted to carrying out the super user role was associated with positive employee perceptions about the CIS. They also found a positive correlation between super user attitudes toward the CIS and employee attitudes. How super users perceived their qualifications was also significantly associated with employee outcomes. These individuals enhanced the perceptions among employees about the usefulness and ease of use of the CIS. Super users also provided clinical staff members with supplementary development of informatics competencies in the form of just-in-time training at the point the staff are doing actual work. (Medical Care Research and Review, January 2009)
- Pharmacists working at 68 community chain pharmacies in 5 States reviewed 2,690 prescription orders. Intervention was required for 3.8 percent of the e-prescriptions reviewed. Most of these interventions (32 percent) were done to obtain missing information, usually medication instructions. Dosing errors were the second most frequent reason for intervention (18 percent). Prescribers were most often contacted (64 percent) to resolve problems. In the majority of cases (56 percent), the prescription order was changed and dispensed correctly. Only 10 percent of problem prescriptions were not dispensed, while 12 percent of cases remained unresolved despite the intervention. Each intervention took the community pharmacist an average of 6 minutes to complete at a cost of $4.74 per each problem prescription. (Journal of the American Pharmacists Association January/February 2009)
Health IT Implementation Stories
AHRQ-funded health IT projects are helping to revolutionize everyday clinical practice. Following are some stories and lessons learned from some of these pioneering projects.
- Integrated reporting system—With this system, doctors at Mt. Ascutney Hospital in Vermont can log onto a Web site and access a patient's electronic health record, including digitalized images of a recent CT scan. To implement this system, the hospital, along with its consortium partners, received a $685,000 grant from AHRQ. Previously, a doctor might have to search through a paper chart and multiple databases to gather lab results and other relevant information on a patient. The integrated reporting system should improve the quality of care provided to patients, particularly those with chronic diseases. The new system has been used to provide information on diabetes to the Vermont Department of Health's chronic care registry. More than 50 percent of people with chronic diseases such as diabetes and asthma fail to get adequate treatment, according to the Vermont Department of Health.
- Health center electronic medical records—With help from a $1.5 million grant from AHRQ, the Sarah Bush Lincoln Health Center in East Central Illinois has been able to extend its centralized EHR application to an expanding group of area clinics. This system is able to capture all patient health information resulting from hospital-based care. The hospital began by implementing a variety of technologies, including an EHR system, CPOE, and e-prescribing in regional clinics and home health practices. To date, six clinics have implemented all of these electronic health systems. There are plans to implement EHR, CPOE, and e-prescribing systems in a total of 11 clinics, making it possible to share longitudinal electronic medical records for every patient that is treated in the hospital or these participating clinic locations.
Prevention/Care Management Portfolio
The mission of the Prevention/Care Management Portfolio is to improve the quality, safety, efficiency, and effectiveness of the delivery of evidence-based preventive services and chronic care management in ambulatory care settings. This mission is accomplished by:
- Supporting clinical decisionmaking for preventive services through the generation of new knowledge, the synthesis of evidence, and the dissemination and implementation of evidence-based recommendations.
- Supporting the evidence base for and implementation of activities to improve primary care and clinical outcomes through:
- Health care redesign.
- Clinical-community linkages.
- Self management support.
- Integration of health information technology.
- Care coordination.
The programmatic work of the Portfolio is carried out through grants and contracts to generate new knowledge, to synthesize and disseminate evidence, and to facilitate implementation of evidence-based primary care. The Portfolio fulfills AHRQ's congressionally mandated role to convene and provide ongoing administrative, scientific and dissemination support to the United States Preventive Services Task Force (USPSTF).
AHRQ Support of the United States Preventive Services Task Force (USPSTF)
The USPSTF is an independent panel of nationally renowned, non-federal experts in prevention and evidence-based medicine comprising primary care clinicians (e.g., internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists) with strong science backgrounds. In FY09, the USPSTF continued to provide "gold standard" recommendations that are the evidence base for clinical preventive services provided in this Nation.
The USPSTF was first convened by the U.S. Public Health Service in 1984 and in 1995 programmatic responsibility for the USPSTF was transferred to AHRQ. Since its inception, the USPSTF has worked to fulfill its mission of:
- Assessing the benefits and harms of preventive services in people asymptomatic for the target condition, based on age, gender, and risk factors for diseases.
- Making recommendations about which preventive services should be incorporated routinely into primary care practice.
USPSTF recommendations are intended to improve clinical practice and promote public health. The USPSTF's scope is specific: its recommendations address primary or secondary preventive services targeting conditions that represent a substantial burden in the United States and are provided in primary care settings or available through a primary care referral.
During FY09, the USPSTF released the following new or updated recommendations in the areas of screening, counseling, and preventive medications:
- Colorectal Cancer—In a change from its previous recommendation, the USPSTF now recommends that adults age 50 to 75 be screened for colorectal cancer using annual high-sensitivity fecal occult blood testing, sigmoidoscopy every 5 years with fecal occult testing between sigmoidoscopic exams, or colonoscopy every 10 years.
- Depression in Children and Adolescents—The USPSTF recommends screening adolescents for clinical depression only when appropriate systems are in place to ensure accurate diagnosis, treatment, and follow-up care. This applies to all adolescents 12 to 18 years of age. In a separate recommendation, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening children 7 to 11 years of age for clinical depression.
- Hepatitis B Infection in Pregnant Women—The USPSTF recommends that clinicians screen all pregnant women for hepatitis infection at their first prenatal visit. This recommendation reaffirms the USPSTF's 2004 recommendation on screening for Hepatitis B infection with respect to pregnant women.
- Hyperbilirubinemia—The USPSTF concludes that the current evidence is insufficient to recommend screening infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy.
- Skin Cancer—The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using a whole-body skin examination by a primary care clinician or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in adults.
- Syphilis in Pregnant Women—The USPSTF recommends that clinicians screen all pregnant women for syphilis infection. This recommendation reaffirms the USPSTF's 2004 recommendation on screening for syphilis infection with respect to pregnant women.
- Impaired Visual Acuity in Older Adults—The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for visual acuity for the improvement of outcomes in older adults.
- Primary Care Interventions to Promote Breastfeeding—The USPSTF recommends primary care interventions during pregnancy and after child birth to encourage and support breastfeeding.
- Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women—The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. The USPSTF also recommends that clinicians ask all pregnant women about tobacco use and provide augmented, pregnancy-tailored counseling for those who smoke.
- Behavioral Counseling to Prevent Sexually Transmitted Infections—The USPSTF recommends high-intensity behavioral counseling to prevent sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk for STIs. The USPSTF also concluded that the current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually-active adolescents and in adults not at increased risk for STIs.
- Aspirin for the Prevention of Cardiovascular Disease—The USPSTF recommends that men between the ages of 45 and 79 use aspirin to reduce their risk for heart attacks when the benefits outweigh the harms for potential gastrointestinal bleeding. The USPSTF recommends that women between the ages of 55 and 79 should use aspirin to reduce their risk for ischemic stroke when the benefits outweigh the harms for potential gastrointestinal bleeding. The USPSTF recommends against using aspirin to prevent heart attacks in men younger than 45 or strokes in women younger than 55.
- Folic Acid To Prevent Neural Tube Defects—The USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.4 mg to 0.8 mg (400 to 800 g) of folic acid. The USPSTF found convincing evidence that taking supplements containing 0.4 to 0.8 mg (400 to 800 g) of folic acid in the periconceptional period reduces the risk for neural tube defects.
Publications based on USPSTF recommendations
AHRQ has made available the following publications based on USPSTF recommendations:
- The annually updated Guide to Clinical Preventive Services includes USPSTF recommendations on screening, counseling, and preventive medication topics and includes clinical considerations for each topic. The 2009 Guide offers recommendations on clinical preventive services made by the USPSTF from 2001 to March 2009. It is available both in published form as a pocket guide and on the AHRQ Web site.
- Men: Stay Healthy at Any Age, Your Checklist for Health and Women: Stay Healthy at Any Age, Your Checklist for Health show at a glance what the USPSTF recommends regarding screening tests and preventive medicine. Healthy lifestyle behaviors are also addressed. (Available in English and Spanish.)
- Men: Stay Healthy at 50+, Checklist for Your Health and Women: Stay Healthy at 50+, Checklist for Your Health show at a glance what the USPSTF recommends regarding screening tests and preventive medicine. Healthy lifestyle behaviors are also addressed. (Available in English and Spanish.)
- Adult Preventive Care Timeline and Staying Healthy at 50+ Timeline posters show at a glance what the USPSTF recommends regarding screening tests.
USPSTF: Focus on Children and Adolescents
USPSTF: Focus on Children and Adolescents describes how the USPSTF develops new methods and procedures to make recommendations for children and adolescents, striving for the goal of improving the health of America's children and adolescents. For example, the Child Health Work Group has developed an analytic framework that is specific to child and adolescent health topics and that considers developmental pathways and trends. The USPSTF uses the framework to guide the search for and evaluation of evidence on child and adolescent health topics. For more information, go to http://www.uspreventiveservicestaskforce.org/tfchildcat.htm.
Cardiovascular Diseases: Patient Brochures and Clinician Fact Sheets
Cardiovascular Diseases: Patient Brochures and Clinician Fact Sheets were developed in partnership with the Department of Veterans Affairs to inform both patients and health care providers about the USPSTF recommendations for cardiovascular disease screening tests, preventive medicine, and other healthy lifestyle behaviors. For further information, go to http://innovations.ahrq.gov/content.aspx?id=2620.
For more information on the USPSTF and prevention resources visit .
Electronic Preventive Services Selector (ePSS)
The Electronic Preventive Services Selector (ePSS) is a tool that is both Web-based and downloadable to a PDA allowing clinicians to access USPSTF recommendations, clinical considerations, and selected practice tools at the point of care. It is designed to help primary care clinicians identify and offer the screening, counseling, and preventive medication services that are appropriate for their patients. The ePSS offers the current, evidence-based recommendations of the USPSTF and can be searched by specific patient characteristics, such as age, sex, and selected behavioral risk factors. In FY09, the ePSS became an official application for iPhones. Further information is available at http://epss.ahrq.gov.
The ePSS and San Francisco General Hospital
AHRQ's ePSS is being used by primary care physicians and nurse practitioners at San Francisco General Hospital to provide evidence-based support to primary care providers on recommended preventive health services. The fact that the ePSS tool is evidence-based and that it is automatically updated as new recommendations are released from the USPSTF is important to the hospital. Providers who have a question regarding what screening tests should be offered for a given patient can quickly access the tool for guidance and, thus, it improves patient care by standardizing care. By implementing the tool, the hospital no longer needed to devote resources to continually updating their internal recommendations. The ePSS link was easily added to the hospital's existing electronic medical record system, and can be found in each patient's health maintenance screen.
Primary Care Practice-Based Research Networks
The Agency supports research networks that rapidly develop and assess methods and tools to assure that new scientific evidence is incorporated into clinical care in real-world practice settings. These networks include a group of ten primary care practice-based research networks (PBRNs) comprised of over 2000 community-based practices that are located across the country and provide primary care services for 12 million Americans. Since 2000, AHRQ has funded over 52 PBRNs through targeted grant programs and it has provided technical and networking assistance for many others. Currently, 101 networks from across the country are registered with AHRQ's PBRN Resource Center and are thus eligible to receive technical and other support from the PBRN Resource Center.
Practice-Based Research Network Resource Center
Since 2002, AHRQ has supported the Practice-Based Research Network Resource Center. The Center manages a national registry of active primary care PBRNs across the country, and provides resources and assistance to registered PBRNs engaged in clinical and health services research. In addition, AHRQ provides PBRNs with grant funding and supports PBRNs through an annual conference, an electronic PBRN search repository, public and private listservs, and a dedicated private community extranet.
Understanding the Costs of Collecting and Reporting Quality Measurement Data in Primary Care Practice
In 2008-2009 AHRQ funded two PBRNs—the State Network of Colorado Ambulatory Practices and Partners (SNOCAP-USA), based in Denver, and the North Carolina Network Consortium (NCNC), based in Chapel Hill, NC—to study the direct and indirect costs of implementing and maintaining quality measurement data collection and reporting in small to medium-sized primary care practices. The two networks recruited a diverse group of practices that had implemented systems for collecting and reporting quality measures, including practices with and without EHRs or membership in and support from health plans. Both networks concluded that the associated costs to practices are quantifiable and significant and that most practices lack both the resources and incentives for doing this work. While practices indicated that they were largely dependent upon external resources to implement and maintain a quality improvement initiative, the investigators concluded that practices realized major benefits on multiple levels through performing quality data collection and using the data in quality improvement activities. The results of these projects were presented at the September 2009 AHRQ annual meeting, and papers reporting the results of the work are currently under consideration by peer-reviewed journals.
PBRN research in progress
AHRQ has awarded master contracts to 10 PBRNs or PBRN consortia and the participating networks have received funding for 12 task orders. Two examples of projects carried out under PBRN task orders are:
- Three PBRNs supported by AHRQ are examining the best methods and procedures for primary care practices to follow in managing patients suspected of having infections caused by MRSA. The three networks, based in North Carolina, Colorado, and Iowa, are testing various clinical strategies in the assessment and treatment of patients who present to their primary care clinician with a soft tissue infection. It is expected that evaluations of these strategies will be completed by 2010, after which time a summary of the best practices will be disseminated widely.
- The NCNC is being funded to develop the AHRQ Health Literacy Universal Precautions Toolkit. Given the numerous and serious effects of limited health literacy on patient safety, medication adherence, and disease management, and the inability of clinicians to tell from visual inspection whether a person has low health literacy, health experts have advocated for the adoption of universal precautions. Such precautions require a restructuring of the practice to reduce the health literacy demands made upon all patients. Through this task order, NCNC will evaluate a number of health literacy strategies currently being used and compile a toolkit consisting of tools that have been assessed as being useful to practices and can be made available in the public domain. The toolkit will also contain instructions on how to use each tool.
For more information on the PBRNs and their research projects, go to http://pbrn.ahrq.gov.
Preparing for Public Health Emergencies
AHRQ has supported research and the development of models, tools, and reports to assess, plan, and improve the ability of the U.S. health care system to respond to public health emergencies that result from natural, biological, chemical, nuclear, and infectious disease events. These initiatives focus on an array of issues related to clinicians, hospitals, and health care systems, including the need to establish linkages among these providers with local and State public health departments, emergency management personnel, and others preparing to respond to events that have the potential to cause mass casualties. Over the past 10 years, AHRQ has funded more than 60 emergency preparedness-related studies, workshops, and conferences to help hospitals and health care systems prepare for public health emergencies. AHRQ's Public Health Emergency Preparedness (PHEP) Research Program has been a primary collaborating science partner with the Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response (ASPR) since the office's inception. Many of the emergency preparedness planning tools developed by PHEP have been made possible through funding from ASPR.
New AHRQ tool estimates transportation needs in emergency situations
In December 2008, AHRQ released a model to help Federal, State, and local emergency planners estimate the number of vehicles and drivers, road capacity, and other resources necessary to evacuate patients and others from health care facilities in disaster areas. Emergency planners can enter into the model any number of evacuating and receiving facilities and specific conditions that could affect transportation plans. The model will estimate the resources and hours needed to move patients from evacuating facilities to receiving facilities, based on assumptions that the planner specifies. The Web-based Mass Evacuation Transportation Planning Model was developed by AHRQ and the Department of Defense with funding from the Department of Homeland Security's Federal Emergency Management Agency and the HHS Office of the Assistant Secretary for Preparedness and Response.
Hospital Surge Model estimates resources needed to handle major disasters
Released in March 2009, the Web-based Hospital Surge Model estimates the resources needed in a hospital to treat casualties resulting from specific scenarios, including biological, chemical, nuclear, or radiological attacks. The Hospital Surge Model estimates:
- The number of casualties arriving at the hospital by arrival condition (e.g., mild or severe symptoms) and day.
- The number of casualties in the hospital by unit (emergency department, intensive care unit, or floor) and day.
- The cumulative number of dead or discharged casualties by day.
- The required hospital resources (e.g., personnel, equipment, and supplies) to treat casualties by unit and day.
Recommendations for caring for children in schools and hospitals during public health emergencies
AHRQ released two new tools designed to protect and care for children who are in a hospital or a school during a public health emergency. The first tool, Pediatric Hospital Surge Capacity in Public Health Emergencies, consists of guidelines to assist pediatric hospitals in converting from standard operating capacity to surge capacity and help community hospital emergency departments provide care for large numbers of critically ill children. The tool addresses needs such as communications, staff responsibilities, triaging, stress management, and security concerns when handling large numbers of children with either communicable respiratory diseases or communicable foodborne or waterborne illnesses.
The second tool, School-Based Emergency Preparedness: A National Analysis and Recommended Protocol, is a national model for school-based emergency response planning. It provides guidance on the recommended steps for both creating and implementing a school-based emergency response plan. Steps outlined include performing needs assessments, conducting site surveys, developing training modules for school staff, and informing parents of the plan, as well as steps relating to building security and safety, preparation for large-scale emergencies, sheltering-in-place and lockdown, evacuation, relocation, and communications.