Evidence-Based Practice for Public Health Emergency Preparedness and Response (2020) / Chapter Skim
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1 Advancing Public Health Emergency Preparedness and Response System Capabilities to Respond to Increasing Threats
1 Advancing Public Health Emergency Preparedness and Response System Capabilities to Respond to Increasing Threats
Pages 23-48
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Yet, little concerted effort has been made to establish a scientific evidence base to guide and inform the actions of SLTT public health agencies, and public health emergency preparedness and response (PHEPR) practitioners in particular.
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defined in the Centers for Disease C Control and Prevention's Public Health Emergency Preparedness and Response apabilities: ational C N Standards for State, Local, Tribal, and Territorial Public Health to prioritize for inclusion in the compre hensive review, with an emphasis given to those capabilities determined by the committee to be most critical to preparedness and response. In identifying preparedness and response practices to evaluate for each of the prioritized PHEPR capabilities and functions, the committee will focus on practices applicable to state, territorial, local, and tribal public health preparedness and response practitioners.
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These 15 capabilities, updated in 2018, are defined in the agency's Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health (PHEPR Capabilities) (CDC, 2018; Martinez et al., 2019)
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26 An Optimal Public Health Emergency Preparedness and Response System PROCESS OUTCOMES Supporting the agency response Managing the public health threat RELATED TO RESPONSE AND RECOVERY Public Health Workforce(s) , Knowledge & Awareness Nonhealth External of Threats and Vulnerabilities 3 PROCESS Agencies & Partners, and Ensuring Equity Community 2, 5, 6, 7, 8, 9, 10, 11, 15 Responders 2, 14 OUTCOMES Ensure Safety of RELATED TO PREPAREDNESS Limiting Disease Spread AND MITIGATION Early Warning Systems & Surveillance 12 Crisis Leadership & Management Minimizing Social Decision Making 3 Labs & Diagnostic Tools 12 Disruption Fostering a Prepared & Resilient Community 1 Knowledge / Decision / Action Loop Minimizing Resources & Materials 8, 9 Infrastructure and Fostering a Prepared Environmental Damage & Resilient System Infrastructure Administrative Preparedness Reactive Actions & Emergency Operations (Treatment, Decontamination)
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Emergency Operations Coordination 4. Emergency Public Information and Warning 5.
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To develop a deeper understanding of how the PHEPR Capabilities relate to each other and to various contextual factors and interact within the complex PHEPR system, the committee conducted a search for a framework that would help visualize these relationships and interactions. Previous logic models have been developed to depict various aspects of PHEPR (CDC, 2019b; Gibson et al., 2012; Stoto et al., 2017)
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as a system nested within many integrated, larger systems. Although different sectors will frequently work in isolation, their interconnectivity is often amplified during a public health emergency.
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. CDC's Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health does not define PHEPR practices per se.
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ADVANCING PHEPR SYSTEM CAPABILITIES 31 PHEPR Practice type of process, structure, or intervention whose implementation is intended to mitigate the adverse effects resulting from a public health emergency Systems Individual Level Organizational Level Targets policies, Level Targets individuals legislation, response Targets public health who may be or are systems, and agencies or other impacted by a public technologies partner health emergency organizations Examples Examples Examples Surveillance systems, Information and data Dispensing and systems to map at-risk sharing practices, administering of medical populations, emergency operations countermeasures, quarantine legal coordination, staffing preparedness training, authorities strategies mental health interventions FIGURE 1-2 Levels of PHEPR practices.
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. Guided by PAHPA and the 2008 IOM letter report on PHEPR research priorities, CDC invested $57 million in research grants through 3 The comprehensive list of potential PHEPR practices is included in the commissioned paper documenting the scoping review, titled "Review and Evidence Mapping of Scholarly Publications Within CDC's 15 Public Health Emergency Preparedness and Response Capabilities," by Testa and colleagues (see Appendix D)
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note a lack of cumulative knowledge across the field because very few studies have developed and tested clear hypotheses based on existing evidence. Several aspects of the current PHEPR field, detailed below, help explain why the development of a robust evidence base for PHEPR practices has been challenging: • a rapidly evolving PHEPR system, • the increasing complexity of public health emergencies and the PHEPR system, • methodological challenges for PHEPR research, • a poorly organized approach to PHEPR research and implications for the PHEPR researcher pipeline, and • a well-documented gap between PHEPR research and practice.
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34 FIGURE 1-3 PHEPR system timeline: Events, policy, and legislation, 1999–2019. SOURCE: Horney, 2019.
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As the PHEPR research field continues to evolve and mature, the committee asserts that a rigorous evidence base is the crucial foundation for future changes in policy and practice.
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the broader global risk environment. Conducting research on the highly complex PHEPR system in the context of an increasingly complex environment, with many unknown public health threats, will require a comprehensive approach to transform how PHEPR research is coordinated, sustainably funded, and conducted.
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The nation now is frequently facing public health emergencies that present opportunities to observe and learn and to conduct real-time research through which to develop a strong empirical and analytical evidence base for PHEPR practices. Furthermore, there is an ever-increasing array of research and evaluation approaches for complex interventions and systems, as well as opportunities to adapt methods from complementary scientific fields, such as anthropology and operations research.
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. Consequently, the numbers of PHEPR researchers are insufficient to address the numerous knowledge gaps in the field.
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. Figure 1-5 captures the various inputs to the evidence-informed decision-making process, and it is important to note that the nature of these inputs may be changing continuously during public health emergency response.
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Moving Beyond the Traditional Evidence Hierarchy for Evaluating the Effectiveness of PHEPR Practices In the evaluation of interventions to improve health, the traditional hierarchy of evidence places systematic reviews of RCTs at the top (strongest evidence) and expert opinion at the bottom (weakest evidence)
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As specified in the Statement of Task for this study (see Box 1-1) , the committee was charged with selecting PHEPR practices to review from within the CDC PHEPR Capabilities (practices specific to the HPP were not within this study's scope)
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In addition to these terms, other important terms are defined throughout the report alongside the relevant discussion. Report Audiences and Uses In developing its evidence review methodology, the committee understood the nature of decision making required in responding to a public health emergency and the need for clear, accessible, and adaptable guidance on evidence-based practices.
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. Public health emergency preparedness and response (PHEPR)
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. Review Methodology, Evidence Reviews, and Recommendations for Evidence-Based PHEPR Practices Chapter 3 describes the committee's proposed methodology for reviewing and evaluating the evidence for PHEPR practices.
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Chapter 2 begins with a high-level overview of the state of PHEPR research based on the results of a commissioned scoping review for the 15 PHEPR Capabilities and associated evidence maps identifying key gaps and limitations in
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2018. Public health emergency preparedness and response c apabilities: National standards for state, local, tribal, and territorial public health.
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2015. The evidence base of primary research in public health emergency preparedness: A scoping review and stakeholder consultation.
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2007a. Assessing public health emergency preparedness: Concepts, tools, and challenges.
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