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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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Evidence-Based Practice for
Public Health Emergency
Preparedness and Response

Ned Calonge, Lisa Brown, and Autumn Downey, Editors

Committee on Evidence-Based Practices for
Public Health Emergency Preparedness and Response

Board on Health Sciences Policy

Board on Population Health and Public Health Practice

Health and Medicine Division

A Consensus Study Report of

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Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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This activity was supported by a contract between the National Academy of Sciences and the Centers for Disease Control and Prevention (Contract #200-2011-38807, Task Order 60). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-based practice for public health emergency preparedness and response. Washington, DC: The National Academies Press. https://doi.org/10.17226/25650.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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COMMITTEE ON EVIDENCE-BASED PRACTICES FOR PUBLIC HEALTH EMERGENCY PREPAREDNESS AND RESPONSE

BRUCE (NED) CALONGE (Chair), President and Chief Executive Officer, The Colorado Trust

DAVID M. ABRAMSON, Associate Professor and Director, Program on Population Impact Recovery and Resilience (PiR2), New York University School of Global Public Health

JULIE CASANI, Medical Director of Student Health Services, North Carolina State University

DAVID EISENMAN, Professor in Residence, David Geffen School of Medicine and Fielding School of Public Health, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles

FRANCISCO GARCÍA, Deputy County Administrator and Chief Medical Officer, Pima County, and Professor Emeritus of Public Health, University of Arizona

PAUL HALVERSON, Founding Dean and Professor, Richard M. Fairbanks School of Public Health, Indiana University

SEAN HENNESSY, Professor of Epidemiology and of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania

EDBERT HSU, Associate Professor, Department of Emergency Medicine and Associate Director, Office of Critical Event Preparedness and Response, Johns Hopkins University

NATHANIEL HUPERT, Associate Professor of Medicine and Population Health Sciences, Weill Medical College, and Co-Director, Cornell Institute for Disease and Disaster Preparedness, Cornell University

REBECCA A. MAYNARD, University Trustee Chair Professor of Education and Social Policy, University of Pennsylvania

SUZET McKINNEY, Executive Director and Chief Executive Officer, Illinois Medical District

JANE P. NOYES, Professor of Health and Social Services Research and Child Health, School of Health Sciences, Bangor University, United Kingdom

DOUGLAS K. OWENS, Henry J. Kaiser Jr. Professor, Professor of Medicine and Director, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University

SANDRA QUINN, Professor, Department of Family Science, School of Public Health, University of Maryland

PAUL SHEKELLE, Founding Director, Southern California Evidence-Based Practice Center, RAND Corporation

ANDY STERGACHIS, Professor of Pharmacy and Global Health, Associate Dean, School of Pharmacy, Director, Global Medicines Program, University of Washington

MITCH STRIPLING, National Director, Emergency Preparedness and Response, Planned Parenthood Federation of America

STEVEN M. TEUTSCH, Adjunct Professor, Fielding School of Public Health, University of California, Los Angeles; and Senior Fellow, Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California

TENER GOODWIN VEENEMA, Professor of Nursing and Public Health, School of Nursing and Bloomberg School of Public Health, Johns Hopkins University

MATTHEW WYNIA, Director, Center for Bioethics and Humanities, University of Colorado

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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National Academy of Medicine Fellow

MAHSHID ABIR, Director, Acute Care Research Unit, and Associate Professor, Department of Emergency Medicine, University of Michigan; and Senior Physician Policy Researcher, RAND Corporation

Study Staff

LISA BROWN, Study Co-Director

AUTUMN DOWNEY, Study Co-Director

MEGAN KEARNEY, Associate Program Officer (from November 2019)

LEAH RAND, Associate Program Officer (until August 2019)

MATTHEW MASIELLO, Research Associate (until August 2019)

ALEX REPACE, Senior Program Assistant

REBECCA MORGAN, Senior Research Librarian

KATHLEEN STRATTON, Senior Scholar, Board on Population Health and Public Health Practice

ANDREW M. POPE, Senior Director, Board on Health Sciences Policy

Consultants

LGND, Graphic Design Team

RONA BRIERE, Senior Editor, Briere Associates, Inc.

SGNL Solutions, Science Writer

Commissioned Paper Authors

ETHAN BALK, Center for Evidence Synthesis in Health, Brown University

JEREMY GOLDHABER-FIEBERT, Stanford University

JENNIFER HORNEY, University of Delaware

KARLI KONDO, Portland VA Evidence Synthesis Program

JULIE NOVAK, Wayne State University

SNEHA PATEL, Columbia University

IAN SALDANHA, Center for Evidence Synthesis in Health, Brown University

PRADEEP SOPORY, Wayne State University

MARCIA TESTA, Harvard University

Public Health Emergency Preparedness and Response Subject-Matter Consultants

JESSICA CABRERA-MARQUEZ, Puerto Rico Department of Health

CARINA ELSENBOSS, Public Health Seattle and King County

STEVEN HULEATT, West Hartford-Bloomfield Health District

CHRISTIE LUCE, Florida Department of Health

PATRICK LUJAN, Guam Department of Public Health and Social Services

DAVID NEZ, Navajo Department of Health

PAUL PETERSON, Tennessee Department of Health

LOU SCHMITZ, American Indian Health Commission for Washington State

EDNA QUINONES-ALVAREZ, Puerto Rico Department of Health

Evidence Review Methodology Subject-Matter Consultant

HOLGER SCHÜNEMANN, McMaster University

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by ENRIQUETA C. BOND, Burroughs Wellcome Fund, and LINDA C. DEGUTIS, Henry M. Jackson Foundation. They were responsible for making certain that an independent examina-

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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tion of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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Preface

In 1946 the federal government created the Communicable Disease Center to address the spread of malaria in the United States. Building on prior state and local activities to address infectious disease outbreaks through the development of public health laboratories, coordinated quarantine and isolation efforts, and national efforts that included the creation of the Public Health Service, this early version of what would become the Centers for Disease Control and Prevention (CDC) was initially created in response to what today would be called a “public health emergency.”

Infectious disease control remained a core element of public health practice, and as the nation experienced ongoing challenges with seasonal influenza and other new threats began to emerge, CDC funded a small number of state health departments to develop planning around pandemic influenza and bioterrorism preparedness in the late 1990s. The terrorist attacks of September 11, 2001, followed by the anthrax letters the following month, brought into sharp focus the need for a more substantial commitment to preparing for those emergencies that involve a public health response. The Public Health Security and Bioterrorism Preparedness and Response Act was passed in 2002, and the Center for Preparedness and Response at CDC was created in 2003, with unprecedented new funding for states to support preparedness efforts. Since then, the number of events requiring a public health response has been impressive, and not limited to infectious diseases. These events have involved West Nile virus; severe acute respiratory syndrome; the federal smallpox vaccination program; monkey-pox; the 2004–2005 influenza vaccine shortage; the H1N1 virus (swine flu); Hurricanes Katrina and Harvey; Midwest and Rocky Mountain West floods; California wildfires; several regional national food recalls for E. coli O157, Salmonella, and Listeria; and Ebola virus—just to name those that reached national attention.

Policy makers have recognized the need for rigor in public health’s emergency planning and response activities, but while investments have been made in research, this funding has been sporadic, not well coordinated, and not always focused on the needs of public health practitioners. The result has been a relatively sparse evidence base for public health emer-

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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gency preparedness and response (PHEPR) practices, reflecting broad variation in research design, implementation, reporting, synthesis, and translation.

Recognizing the substantial benefit for human health that could be realized through an evidence-based approach to identifying those practices that warrant being recommended to PHEPR practitioners, leaders from CDC’s Center for Preparedness and Response commissioned the National Academies of Sciences, Engineering, and Medicine to undertake a study focused on developing an evidence synthesis methodology specific to PHEPR practices and piloting that methodology by evaluating a number of practices important to practitioners in the field. Bringing together experts in research methods and evidence synthesis and leaders and researchers in PHEPR, the study committee created a customized evidence review and synthesis and evidence-to-recommendation methodology that recognizes the value of and utilizes the full body of available research. Creating this methodology thus entailed applying synthesis methods created for both quantitative and qualitative data, as well for more novel evidence categories that encompassed parallel evidence (i.e., evidence regarding the same or similar intervention but in different contexts), mechanistic evidence (i.e., evidence based on an identifiable causal link or pathway, generally previously established in other fields), and case reports and after action reports (prepared as a standard practice in review and evaluation of public health emergency response).

The committee applied this methodology in formulating recommendations and guidance for specific practices in four of CDC’s 15 Preparedness and Response Capabilities1: engaging with and training community-based partners to improve the outcomes of at-risk populations (falls under Capability 1, Community Preparedness); activating a public health emergency operations center (Capability 3, Emergency Operations Coordination); communicating public health alerts and guidance with technical audiences during a public health emergency (Capability 6, Information Sharing); and implementing quarantine to reduce or stop the spread of a contagious disease (Capability 11, Non-Pharmaceutical Interventions). The process by which these four diverse practices were selected was designed in such a way as to ensure that the committee’s evidence synthesis methodology can be applied to other practices that fall under all 15 Capabilities. It was not, however, a prioritization process based on importance; all 15 Capabilities are critical to the preparation for and response to a public health emergency. As it is applied to other practices, the committee is confident its methodology will continue to evolve to provide public health leaders with guidance based on the best available evidence—the key tenet of evidence-based practice.

A NOTE ON COVID-19

In the final weeks of the committee’s work, a public health emergency of international concern emerged with the outbreak of the novel coronavirus responsible for the COVID-19 pandemic. We recognized that each of the practices we had evaluated with our methodology, which were selected roughly 2 years prior to the emergence of this disease, were operative to some extent in the response to this emergency: working with community-based organizations

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1 The other 11 Capabilities are Community Recovery (Capability 2), Emergency Public Information and Warning (Capability 4), Fatality Management (Capability 5), Mass Care (Capability 7), Medical Countermeasure Dispensing (Capability 8), Medical Materiel Management and Distribution (Capability 9), Medical Surge (Capability 10), Public Health Laboratory Testing (Capability 12), Public Health Surveillance and Epidemiological Investigation (Capability 13), Volunteer Management (Capability 14), and Responder Safety and Health (Capability 15), as defined in CDC (Centers for Disease Control and Prevention). 2018. Public health emergency preparedness and response capabilities: National standards for state, local, tribal, and territorial public health. https://www.cdc.gov/cpr/readiness/00_docs/CDC_PreparednesResponseCapabilities_October2018_Final_508.pdf (accessed March 11, 2020).

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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to address the needs of at-risk populations (Chapter 4); activation of an emergency operation center (Chapter 5); communication with health care providers and other technical audiences (Chapter 6); and, of particular note, quarantine (Chapter 7). Although our reviews were not conducted in response to the COVID-19 pandemic, the likely applicability of many of our findings is noteworthy. For example, while it is too soon to conclude definitively whether quarantine is effective at reducing and stopping transmission of this novel coronavirus, the findings from the qualitative evidence synthesis (discussed in Chapter 7) regarding the psychological and financial harms of this practice will undoubtedly be just as relevant to the current quarantine experience as they are to past outbreak scenarios. Given the rapid and evolving nature of the COVID-19 pandemic and the speed at which new studies are being published on non-peer-reviewed, preprint servers, it was not possible at this time to update the committee’s evidence reviews to incorporate studies examining the implementation of the four PHEPR practices reviewed for this study as applied to COVID-19. However, it will be important to expand and update these reviews once the field has rigorously collected, analyzed, and published the relevant data and information.

The emergence of COVID-19 has highlighted critical evidence gaps and lost opportunities to expand the evidence base for these and other PHEPR practices. The lack of interoperable and harmonized data and capacity for local-level monitoring impedes both evidence-based research and response. It reinforces the critical, ongoing need to have processes and programs in place to perform research and evaluation, even in real time, to better inform future decisions. Without these systems in place before, during, and after the unfolding of a disaster, it will be extremely difficult to build the PHEPR evidence base prospectively and retrospectively.

The release of this report in the context of the COVID-19 pandemic puts the challenges of limited research to support evidence-based PHEPR practices in bold relief. The committee’s recommendations around adequate stable funding, robust design and conduct of research studies, development of the research workforce and programs, and a commitment to collaboration between public health practitioners and experienced researchers all are vital to ongoing support of the knowledge development for and implementation of interventions that will better protect the public’s health and minimize the impact of the broad spectrum of emergencies that have and will certainly continue to threaten the security of the nation. The unprecedented costs of COVID-19 show that the nation cannot afford to ignore the calls for these critical investments in public health that have been made by this committee and many others before.

Ned Calonge, Chair
Committee on Evidence-Based Practices for Public Health Emergency Preparedness and Response

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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About This Report

Study Approach and Scope

Report Audiences and Uses

Organization of the Report

References

2 THE LANDSCAPE AND EVOLUTION OF PUBLIC HEALTH EMERGENCY PREPAREDNESS AND RESPONSE RESEARCH IN THE UNITED STATES

Characterizing the Research on PHEPR: A Map of the Evidence

Overall Distribution of Articles Within the 15 PHEPR Capabilities

Quantitative Impact Studies Within the 15 PHEPR Capabilities

Studies Within Specific Practice Areas of the 15 PHEPR Capabilities

Implications for Future Research and Evidence Reviews

A Look Back at PHEPR Research Programs

Centers for Disease Control and Prevention–Funded Academic PHEPR Workforce Development and Research Centers

Other Federal Disaster Research Programs

Specific Efforts to Enhance the Conduct of Research During Public Health Emergencies

Limitations of PHEPR Research Programs

Misaligned and Unclear Research Priorities

Lack of Infrastructure to Support the Conduct of Quality PHEPR Research

Lack of Coordination Across Funders and Shortcomings of Research Funding

Concluding Remarks

References

3 AN EVIDENCE REVIEW AND EVALUATION PROCESS TO INFORM PUBLIC HEALTH EMERGENCY PREPAREDNESS AND RESPONSE DECISION MAKING

Evolving Philosophies for Evaluating Evidence to Inform Evidence-Based Practice: Implications for PHEPR

Limitations of the Traditional Evidence Hierarchy

Evolving Methods for Evaluating Complex Health Interventions in Complex Systems

Implications for Evaluating Evidence in the PHEPR System

How Do Different Fields Evaluate Evidence?: A Review of Existing Frameworks

Applying a Methodology to Review, Synthesize, and Assess the COE for PHEPR Practices

Formulating the Scope of the Reviews and Searching the Literature

Synthesizing and Assessing the COE

Formulating the Practice Recommendations and Implementation Guidance

Limitations, Lessons Learned, and Recommendations for the Future

Limitations of the Committee’s Evidence Review and Evaluation Methodology

Reflections and Lessons Learned from the Mixed-Method Reviews

Need for Ongoing PHEPR Evidence Reviews

An Infrastructure to Sustain PHEPR Evidence Reviews

References

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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4 ENGAGING WITH AND TRAINING COMMUNITY-BASED PARTNERS TO IMPROVE THE OUTCOMES OF AT-RISK POPULATIONS

Description of the Practice

Defining the Practice

Scope of the Problem Addressed by the Practice

Overview of the Key Review Questions and Analytic Framework

Defining the Key Review Questions

Analytic Framework

Overview of the Evidence Supporting the Practice Recommendation

Effectiveness

Balance of Benefits and Harms

Acceptability and Preferences

Feasibility and PHEPR System Considerations

Resource and Economic Considerations

Equity

Ethical Considerations

Considerations for Implementation

Facilitators for CBP Engagement

Facilitators for CBP Training

Practice Recommendation, Justification, and Implementation Guidance

Evidence Gaps and Future Research Priorities

References

5 ACTIVATING A PUBLIC HEALTH EMERGENCY OPERATIONS CENTER

Description of the Practice

Defining the Practice

Scope of the Problem Addressed by the Practice

Overview of the Key Review Questions and Analytic Framework

Defining the Key Review Questions

Analytic Framework

Overview of the Evidence Supporting the Practice Recommendation

Effectiveness

Balance of Benefits and Harms

Acceptability and Preferences

Feasibility and PHEPR System Considerations

Resource and Economic Considerations

Equity

Ethical Considerations

Considerations for Implementation

Factors in Determining When to Activate a PHEOC

Other Implementation Considerations

Practice Recommendation, Justification, and Implementation Guidance

Evidence Gaps and Future Research Priorities

References

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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6 COMMUNICATING PUBLIC HEALTH ALERTS AND GUIDANCE WITH TECHNICAL AUDIENCES DURING A PUBLIC HEALTH EMERGENCY

Description of the Practice

Defining the Practice

Scope of the Problem Addressed by the Practice

Overview of the Key Review Questions and Analytic Framework

Defining the Key Review Questions

Analytic Framework

Overview of the Evidence Supporting the Practice Recommendation

Effectiveness

Balance of Benefits and Harms

Acceptability and Preferences

Feasibility and PHEPR System Considerations

Resource and Economic Considerations

Equity

Ethical Considerations

Considerations for Implementation

Engaging Technical Audiences in the Development of Communication Plans, Protocols, and Channels

Considerations for Selection of Communication Channels

Facilitating Communication with Technical Audiences During a Public Health Emergency

Practice Recommendation, Justification, and Implementation Guidance

Evidence Gaps and Future Research Priorities

References

7 IMPLEMENTING QUARANTINE TO REDUCE OR STOP THE SPREAD OF A CONTAGIOUS DISEASE

Description of the Practice

Defining the Practice

Scope of the Problem Addressed by the Practice

Overview of the Key Review Questions and Analytic Framework

Defining the Key Review Questions

Analytic Framework

Overview of the Evidence Supporting the Practice Recommendation

Effectiveness

Findings from a Synthesis of Modeling Studies: Quarantine Is More Effective Under Certain Circumstances

Balance of Benefits and Harms

Acceptability and Preferences

Feasibility and PHEPR System Considerations

Resource and Economic Considerations

Equity

Ethical Considerations

Considerations for Implementation

Facilitating Adherence to and Minimizing Harms from Quarantine Measures

Other Implementation Considerations

Practice Recommendation, Justification, and Implementation Guidance

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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Evidence Gaps and Future Research Priorities

Quarantine and the COVID-19 Pandemic

References

8 IMPROVING AND EXPANDING THE EVIDENCE BASE FOR PUBLIC HEALTH EMERGENCY PREPAREDNESS AND RESPONSE

A National PHEPR Science Framework

Key Components of a National PHEPR Science Framework

Ensuring Adequate Infrastructure and Supporting Mechanisms to Facilitate the Conduct of PHEPR Research

Conclusion and Recommendations

Supporting Methodological Improvements for PHEPR Research

Common Evidence Guidelines

Standards for Reporting of Study Information

Conclusion and Recommendation

Improving Systems to Generate High-Quality Experiential Evidence for PHEPR

Limitations of AARs as a Source of Experiential Evidence for Mixed-Method Evidence Reviews

Strengthening Methodological Approaches

Establishing Mechanisms for Analysis and Dissemination of Lessons Learned from AARs

Fostering a Culture of Quality Improvement

Conclusions and Recommendation

Workforce Capacity Development for Researchers and Practitioners in PHEPR

Researchers

Practitioners

Conclusion and Recommendation

Translation, Dissemination, and Implementation of PHEPR Research to Practice

Building Implementation Capacity

Conclusion and Recommendation

Annex 8-1 Genres of Research to Inform Public Health Emergency Preparedness and Response Practices

References

APPENDIXES

A DETAILED DESCRIPTION OF THE COMMITTEE’S METHODS FOR FORMULATING THE SCOPE OF THE REVIEWS AND CAPTURING THE EVIDENCE

B MIXED-METHOD REVIEWS OF SELECTED TOPICS

B-1 MIXED-METHOD REVIEW OF STRATEGIES FOR ENGAGING WITH AND TRAINING COMMUNITY-BASED PARTNERS TO IMPROVE THE OUTCOMES OF AT-RISK POPULATIONS

B-2 MIXED-METHOD REVIEW OF ACTIVATING A PUBLIC HEALTH EMERGENCY OPERATIONS CENTER

B-3 MIXED-METHOD REVIEW OF CHANNELS FOR COMMUNICATING PUBLIC HEALTH ALERTS AND GUIDANCE WITH TECHNICAL AUDIENCES DURING A PUBLIC HEALTH EMERGENCY

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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5-3 Key Review Questions

6-1 How Communicating Public Health Alerts and Guidance with Technical Audiences During a Public Health Emergency Relates to the Centers for Disease Control and Prevention’s PHEPR Capabilities

6-2 Key Review Questions

7-1 How Quarantine Relates to the Centers for Disease Control and Prevention’s PHEPR Capabilities

7-2 Key Review Questions

8-1 Components of a PHEPR Research Agenda

8-2 11-Item Tool for Assessing the Methodological Rigor of After Action Reports

8-3 The Committee’s Suggested Elements for a PHEPR After Action Report Template

A-1 Seminal Literature Sources for the Committee’s Evidence Review Methodology

A-2 Selection Criteria for Review Topics

A-3 PICOTS Criteria for Inclusion and Exclusion of Articles

A-4 Data Extraction Elements for Quantitative Studies

A-5 Priority Topics for Future PHEPR Evidence Reviews

B1-1 Key Review Questions

B2-1 Key Review Questions

B3-1 Key Review Questions

B4-1 Key Review Questions

FIGURES

S-1 Key components of a National PHEPR Science Framework

S-2 Framework for integrating evidence to inform recommendation and guidance development for PHEPR practices

1-1 Conceptual framework for an optimal PHEPR system

1-2 Levels of PHEPR practices

1-3 PHEPR system timeline: Events, policy, and legislation, 1999–2019

1-4 Billion-dollar weather and climate disasters, United States, 2019

1-5 Evidence-informed decision making

1-6 Layered approach to the presentation of evidence from the PHEPR practice reviews

2-1 Distribution of evidentiary articles by PHEPR Capability (N = 1,106)

2-2 Type of outcome by PHEPR Capability (N = 1,106)

2-3 Evidence map: Characteristics of U.S. quantitative impact studies across the PHEPR Capabilities (N = 72)

2-4 Evidence map: Characteristics of studies for Medical Countermeasure Dispensing and Administration (N = 110)

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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2-5 Evidence map: Characteristics of studies for Emergency Public Information and Warning (N = 66)

2-6 Major categories of challenges to the conduct of PHEPR research and how they can be addressed

2-7 Total annual U.S. governmental funding for disaster-related research relevant to the 15 Centers for Disease Control and Prevention PHEPR Capabilities, 2008–2017

3-1 Selection process for the committee’s review topics

3-2 Classification and consolidation of studies into methodological streams

3-3 Framework for integrating evidence to inform recommendation and guidance development for PHEPR practices

3-4 Burden (time and intensity) of the committee’s methodology development and mixed-method review process

4-1 Analytic framework for engaging with and training community-based partners to improve the outcomes of at-risk populations

5-1 Analytic framework for public health emergency operations

6-1 Analytic framework for communicating public health alerts and guidance with technical audiences during a public health emergency

7-1 Analytic framework for implementing quarantine during a public health emergency

8-1 Distribution of all scoping review articles by study design (N = 1,692)

8-2 Key components of a National PHEPR Science Framework

8-3 Los Angeles County Community Disaster Resilience mixed-method research study

8-4 Root-cause analysis: Steps and examples

B1-1 Analytic framework for engaging with and training community-based partners to improve the outcomes of at-risk populations

B1-2 Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for the mixed-method review of strategies for engaging with and training community-based partners to improve the outcomes of at-risk populations

B2-1 Analytic framework for public health emergency operations

B2-2 Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for the mixed-method review of activating public health emergency operations

B3-1 Analytic framework for communicating public health alerts and guidance with technical audiences during a public health emergency

B3-2 Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for the mixed-method review of channels for communicating public health alerts and guidance with technical audiences during a public health emergency

B4-1 Analytic framework for implementing quarantine during a public health emergency

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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B4-2 Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for the mixed-method review of implementing quarantine to reduce or stop the spread of a contagious disease

D-1 Distribution of all articles by study design (N = 1,692)

D-2 Study design by PHEPR Capability (N = 1,184)

D-3 Distribution of evidentiary articles by PHEPR Capability (N = 1,106)

D-4 Distribution of evidentiary articles across PHEPR Capabilities (N = 1,106)

D-5 Type of outcome by PHEPR Capability (N = 1,106)

D-6 Type of disaster by PHEPR Capability (N = 1,106)

D-7 Organization by PHEPR Capability (N = 1,106)

D-8 Setting by PHEPR Capability (N = 1,106)

D-9 Evidence map: Characteristics of U.S. quantitative impact studies across the PHEPR Capabilities (N = 72)

D-10 Evidence map: Characteristics of non-U.S. quantitative impact studies across the PHEPR Capabilities (N = 23)

D-11 Evidence map: Characteristics of studies for Community Preparedness (N = 221)

D-12 Evidence map: Characteristics of studies for Community Recovery (N = 78)

D-13 Evidence map: Characteristics of studies for Emergency Operations Coordination (N = 111)

D-14 Evidence map: Characteristics of studies for Emergency Public Information and Warning (N = 66)

D-15 Evidence map: Characteristics of studies for Fatality Management (N = 15)

D-16 Evidence map: Characteristics of studies for Information Sharing (N = 38)

D-17 Evidence map: Characteristics of studies for Mass Care (N = 30)

D-18 Evidence map: Characteristics of studies for Medical Countermeasure Dispensing and Administration (N = 110)

D-19 Evidence map: Characteristics of studies for Medical Materiel Management and Distribution (N = 36)

D-20 Evidence map: Characteristics of studies for Medical Surge (N = 87)

D-21 Evidence map: Characteristics of studies for Non-Pharmaceutical Interventions (N = 112)

D-22 Evidence map: Characteristics of studies for Public Health Laboratory Testing (N = 15)

D-23 Evidence map: Characteristics of studies for Public Health Surveillance and Epidemiological Investigation (N = 102)

D-24 Evidence map: Characteristics of studies for Responder Safety and Health (N = 51)

D-25 Evidence map: Characteristics of studies for Volunteer Management (N = 55)

TABLES

S-1 Key Findings and Practice Recommendations from the Committee’s Evidence Review and Evaluation Process

2-1 Key Federal Stakeholders in Conducting or Supporting Disaster Research

3-1 Examples of Evidence Evaluation Frameworks Reviewed by the Committee

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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3-2 Definitions for the Four Levels of Certainty of the Evidence

3-3 Matrix with the Generalized Approach by Which the Committee Determined the Certainty of the Evidence

4-1 Evidence Types Included in the Mixed-Method Review of Strategies for Engaging with and Training Community-Based Partners to Improve the Outcomes of At-Risk Populations

5-1 Evidence Types Included in the Mixed-Method Review of Activating Public Health Emergency Operations

6-1 Technical Audiences and Communication Channels Used to Share Public Health Alerts and Guidance

6-2 Evidence Types Included in the Mixed-Method Review of Channels for Communicating Public Health Alerts and Guidance with Technical Audiences During a Public Health Emergency

6-3 Considerations for Selection of Communication Channels

7-1 Evidence Types Included in the Mixed-Method Review of Implementing Quarantine

7-2 Summary of Findings on the Effectiveness of Quarantine from 12 Modeling Studies

8-1 Key Components of Research Response in the Context of Public Health Emergencies

8-2 A Brief Overview of Strengths and Limitations of Study Designs for Quantitative Impact Evaluation for PHEPR

8-3 Best Practices for the Translation, Dissemination, and Implementation of Evidence-Based PHEPR Practices

Annex 8-1 Genres of Research to Inform PHEPR Practices: Purpose, Example Research Questions, and Appropriate Methods

B1-1 Evidence Types Included in the Mixed-Method Review of Strategies for Engaging with and Training Community-Based Partners to Improve the Outcomes of At-Risk Populations

B1-2 Effect of Culturally Tailored Preparedness Training Programs on Improved PHEPR Knowledge of Community-Based Partner Representatives

B1-3 Effect of Culturally Tailored Preparedness Training Programs on Improved Attitudes and Beliefs of Community-Based Partner Representatives Regarding Their Preparedness to Meet Needs of At-Risk Individuals

B1-4 Effect of Culturally Tailored Preparedness Training Programs on Community-Based Partner Disaster Planning

B1-5 Effect of Culturally Tailored Preparedness Training Programs for Community-Based Partners and At-Risk Populations They Serve on Improved PHEPR Knowledge of Trained At-Risk Populations

B1-6 Effect of Culturally Tailored Preparedness Training Programs for Community-Based Partners and At-Risk Populations They Serve on Improved Attitudes and Beliefs of Trained At-Risk Populations Regarding Their Preparedness

Page xxiv Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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B1-7 Effect of Culturally Tailored Preparedness Training Programs for Community-Based Partners and At-Risk Populations They Serve on Improved Preparedness Behaviors of Trained At-Risk Populations

B1-8 Effect of Community-Based Partner Engagement in Preparedness Outreach Activities Targeting At-Risk Populations on Improved Attitudes and Beliefs of At-Risk Populations Toward Preparedness Behaviors

B1-9 Effect of Engagement and Training of Community-Based Partners in Coalitions Addressing Public Health Preparedness/Resilience

B1-10 Evidence to Decision Summary Table for Engaging with and Training Community-Based Partners

B2-1 Evidence Types Included in the Mixed-Method Review of Activating Public Health Emergency Operations

B2-2 Evidence to Decision Summary Table for Activation of Public Health Emergency Operations

B3-1 Evidence Types Included in the Mixed-Method Review of Channels for Communicating Public Health Alerts and Guidance with Technical Audiences During a Public Health Emergency

B3-2 Effect of Electronic Messaging System Channels (Email, Text, and Fax) on Improved Technical Audiences’ Awareness of Public Health Alerts and Guidance During a Public Health Emergency

B3-3 Effect of Electronic Messaging System Channels (Email, Text, and Fax) on Improved Technical Audiences’ Use of Public Health Guidance During a Public Health Emergency

B3-4 Evidence to Decision Summary Table for Channels Used to Communicate Public Health Alerts and Guidance with Technical Audiences During a Public Health Emergency

B3-5 Considerations for Selection of Communication Channels

B4-1 Evidence Types Included in the Mixed-Method Review of Implementing Quarantine to Reduce or Stop the Spread of a Contagious Disease

B4-2 Effect of Quarantine on Reduced Overall Disease Transmission in the Community in Certain Circumstances

B4-3 Effect of Quarantine on Reduced Time from Symptom Onset to Diagnosis in Quarantined Individuals

B4-4 Effect of Congregate Quarantine for Influenza and Agents with Similar Transmissibility on Increased Risk of Infection Among Those in the Shared Setting

B4-5 Effect of Quarantine on Psychological Harms in Quarantined Individuals

B4-6 Effect of Quarantine on Financial Hardship in Quarantined Individuals

B4-7 Effect of Health-Promoting Leadership on Reduced Depression and Anxiety Symptoms in Quarantined Individuals

B4-8 Effect of Risk Communication and Messaging and Employment Leave on Improved Adherence to Quarantine Measures

B4-9 Summary of Findings on the Effectiveness of Quarantine from 12 Modeling Studies

B4-10 Evidence to Decision Summary Table for Implementing Quarantine

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
×

Acronyms and Abbreviations

AAR after action report
AHRQ Agency for Healthcare Research and Quality
ASPR Assistant Secretary for Preparedness and Response
ASTHO Association of State and Territorial Health Officials
CASP Critical Appraisal Skills Programme
CBP community-based partner
CDC Centers for Disease Control and Prevention
CERQual Confidence in the Evidence from Reviews of Qualitative Research
COE certainty of the evidence (of effectiveness)
CPHP Center for Public Health Preparedness
CPSTF Community Preventive Services Task Force
DECIDE (project) Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence
DHS U.S. Department of Homeland Security
DoD U.S. Department of Defense
DOI U.S. Department of the Interior
EBM evidence-based medicine
EOC emergency operations coordination/center
EtD Evidence to Decision (framework)
FEMA Federal Emergency Management Agency
GRADE Grading of Recommendations Assessment, Development and Evaluation
HPP Hospital Preparedness Program
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Evidence-Based Practice for Public Health Emergency Preparedness and Response. Washington, DC: The National Academies Press. doi: 10.17226/25650.
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HSDL Homeland Security Digital Library
NACCHO National Association of County & City Health Officials
NIEHS National Institute of Environmental Health Sciences
NSF National Science Foundation
PAHPA Pandemic and All Hazards Preparedness Act
PERLC Preparedness and Emergency Response Learning Center
PERRC Preparedness and Emergency Response Research Center
PHAB Public Health Accreditation Board
PHEOC public health emergency operations center
PHEPR public health emergency preparedness and response
PPHR Project Public Health Ready
RCT randomized controlled trial
RoB risk of bias
ROBINS-I (tool) Risk of Bias in Non-Randomized Studies of Interventions
SLTT state, local, tribal, and territorial
USPSTF U.S. Preventive Services Task Force
WHO World Health Organization
WWC What Works Clearinghouse
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When communities face complex public health emergencies, state local, tribal, and territorial public health agencies must make difficult decisions regarding how to effectively respond. The public health emergency preparedness and response (PHEPR) system, with its multifaceted mission to prevent, protect against, quickly respond to, and recover from public health emergencies, is inherently complex and encompasses policies, organizations, and programs. Since the events of September 11, 2001, the United States has invested billions of dollars and immeasurable amounts of human capital to develop and enhance public health emergency preparedness and infrastructure to respond to a wide range of public health threats, including infectious diseases, natural disasters, and chemical, biological, radiological, and nuclear events. Despite the investments in research and the growing body of empirical literature on a range of preparedness and response capabilities and functions, there has been no national-level, comprehensive review and grading of evidence for public health emergency preparedness and response practices comparable to those utilized in medicine and other public health fields.

Evidence-Based Practice for Public Health Emergency Preparedness and Response reviews the state of the evidence on PHEPR practices and the improvements necessary to move the field forward and to strengthen the PHEPR system. This publication evaluates PHEPR evidence to understand the balance of benefits and harms of PHEPR practices, with a focus on four main areas of PHEPR: engagement with and training of community-based partners to improve the outcomes of at-risk populations after public health emergencies; activation of a public health emergency operations center; communication of public health alerts and guidance to technical audiences during a public health emergency; and implementation of quarantine to reduce the spread of contagious illness.

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