Evidence-Based Practice for Public Health Emergency Preparedness and Response (2020) / Chapter Skim
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Appendix A: Detailed Description of the Committee's Methods for Formulating the Scope of the Reviews and Capturing the Evidence
Appendix A: Detailed Description of the Committee's Methods for Formulating the Scope of the Reviews and Capturing the Evidence
Pages 251-290
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Additional information regarding the complexity perspective that guided the committee's approach to its task can be found in Chapter 3. FORMULATING THE SCOPE OF THE REVIEWS Selecting the Review Topics In response to its charge, the committee developed a process for identifying which of the CDC PHEPR Capabilities would be the focus of its systematic literature reviews.
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Preliminary Literature Review To better understand the current evidence base for PHEPR practices, the committee conducted a preliminary literature review. This preliminary review helped formulate the scope of the final reviews and frame the key review questions that governed the committee's systematic searches of the evidence.
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Methodological diversity: This criterion was specific to the committee's task of developing an evidence review and evaluation methodology for generating recommendations for evidence-based PHEPR practices, and is something that likely would not be considered in selecting topics for future r eviews. Given the context-sensitive, heterogeneous nature of PHEPR practices and their focus on systems and processes, the committee considered how the type of research might vary across the Centers for Disease Control and Prevention's PHEPR Capabilities and the characteristics that might differ across PHEPR practices that are important to interpreting the evidence.
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The committee acknowledges that a different group might have chosen a different set of topics. Given that the committee was able to conduct reviews for only a very small subset of PHEPR practices, it sought to inform future priorities for review topics by commissioning a scoping review and evidence map to examine and describe the extent and the nature of research conducted on practices within all of the CDC PHEPR Capabilities (see Chapter 2 and Appendix D)
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One key finding was that the research question within the community resilience domain related to appropriate methods and procedures for identifying and mapping at-risk populations received the highest importance rating from the practitioners surveyed. As described later in this appendix, the committee leveraged this important work in conducting a structured priority-setting activity to identify priority topics for future systematic evidence reviews (refer to the section below on "Prioritization of Future Systematic Evidence Review Topics")
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Developing the Analytic Frameworks and Key Review Questions Once the four review topics had been selected, the committee focused on further describing and constraining the scope of its reviews through the development of a detailed analytic framework and set of key review questions for each topic. The analytic frameworks and key review questions for each of the four review topics can be found in Chapters 4–7 and Appendixes B1–B4.
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. These sets of key review questions specified the logic and scope of the review of each topic and were critical in guiding the literature searches, data extraction, and evidence analyses.
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A professional librarian worked closely with the committee to plan the literature search strategies, ensure the appropriate translation of the key review questions into relevant and accurate terms, and conduct the searches so as to identify relevant research. Specific details regarding the search strategies and article selection process for each of the four review topics can be found at the end of this appendix.
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Inclusion and Exclusion Criteria The committee developed specific inclusion and exclusion criteria based on the PICOTS framework for each of the four review topics. Generally, the committee did not exclude based on study design, lack of comparison groups, or lack of explicit outcomes (i.e., it included articles that describe lessons learned or present conclusions)
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• ligible Interventions and Comparators* E o Community Preparedness Capability -- Practices used to engage with and train community-based partners to assess and plan for the access and functional needs of at-risk populations that may be disproportion ately impacted by a public health emergency o Emergency Operations Coordination Capability -- Strategies or criteria used by public health agencies to determine when to activate public health emergency operations, with a focus on determining when public health should have a lead response role, a supporting role, or no role based on identified or potential public health consequences o Information Sharing Capability -- Practices used by public health agencies to communicate public health alerts and guid ance with technical audiences during a public health emergency that include actions to increase awareness and understanding of information DATA EXTRACTION AND STUDY QUALITY ASSESSMENT Studies captured in the literature searches for each review topic were placed in six categories: • quantitative comparative studies, • quantitative noncomparative (single-group)
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• ligible Settings E o general, countries deemed to be most generalizable to the United States, taking into In consideration the likely sources of relevant data o Variable across review topics -- Notably, included studies from any country regarding quarantine -- Excluded: for Community Preparedness and Information Sharing, studies from an inter national setting, except those from the United Kingdom, Western Europe, Canada, A ustralia, and New Zealand -- Excluded: for Emergency Operations Coordination, studies from any international set ting, except those from the United Kingdom, Western Europe, Canada, Mexico, Panama, Australia, New Zealand, and Israel o geographic or civic setting, including urban, suburban, or rural; federal, national, state, Any regional, city, or neighborhood; general or focused community (e.g., Latinos, Navajo) ; or other settings *
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I o Provision of information onlyb o Training and/or educationc o Behavioral interventionsd o Environmental interventionse o Public health or medical system interventionsf o Legislation, regulation, and/or enforcementg o ther, none, not applicable, or unclear O • T opics of interest o Community Preparedness Capability (engaging with and training community-based partners) o Emergency Operations Coordination Capability (activating public health emergency operations)
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, each with its own o Information Sharing Capability (communicating public health alerts and guidance with technical audiences) o on-Pharmaceutical Interventions Capability (quarantine)
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Quantitative Studies For quantitative comparative studies, an assessment tool was developed by the Brown University EPC8 by drawing selected RoB domains from existing tools, including the Cochrane Risk of Bias version 2.0 tool (Higgins et al., 2019) , Cochrane's suggested risk-of-bias criteria for Effective Practice and Organisation of Care reviews (Cochrane, 2017)
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• Study population eligibility criteria prespecified and uniformly applied: Low RoB: Explicitly reported, clear, and no major deviations from protocol. High RoB: Not pre specified or major deviation from protocol.
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Qualitative Studies Quality assessment for qualitative studies was undertaken as a component of a qualitative evidence synthesis commissioned to Wayne State University. The qualitative studies meeting the inclusion criteria for each review topic were appraised individually using the Critical Appraisal Skills Programme (CASP, 2018)
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PRIORITIZATION OF FUTURE SYSTEMATIC EVIDENCE REVIEW TOPICS The committee engaged with a second diverse group of 10 PHEPR practitioners, also representing SLTT agencies, in an open session to identify knowledge gaps that matter to practitioners and assess the relative priority, from their perspective, of potential evidence review topics encompassed within the CDC PHEPR Capabilities. This practitioner engagement activity was conducted after the committee's four evidence review topics had been selected and therefore did not inform the selection process.
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BOX A-5 PRIORITY TOPICS FOR FUTURE PHEPR EVIDENCE REVIEWS The committee engaged with state, local, tribal, and territorial practitioners to assess the rela tive priority (from the practitioner perspective) of potential evidence review topics encompassed within the 15 Centers for Disease Control and Prevention Public Health Emergency Preparedness and Response Capabilities.
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• uality and quantity of trainings suggested for key personnel on public health prepared Q ness and response • inimum public health staffing standards for responses (i.e., what are the key positions) M • trategies for optimal logistics management, including medical materiel warehousing and S distribution • trategies for evaluating MCM and non-pharmaceutical intervention courses of action S Topics in the middle: • ata sources (e.g., existing public health, historical, geological, ecological, and sociological D data)
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to medical support, sheltering, and evacuation activities • rocesses and protocols for interjurisdictional epidemiological investigation during an P emergency • ata-sharing and data-use practices for public health surveillance to ensure the privacy, D confidentiality, and security of personal health information in an emergency • ommunication and information-sharing methods for epidemiological response among C public health and external partners • dministrative preparedness procedures, including disaster finance procedures and track A ing prior to, during, and after a response • est practices for working with jurisdictional officials to implement authority and processes B for public health orders, including coordination with necessary law enforcement and health care partners • olunteer involvement, accrual, and retainment V • actors that determine MCM adherence over time F • se of "big data" to rapidly identify, characterize, and forecast the probable trajectory, U duration, and magnitude of threats • ssential elements of public health emergency response readiness specific to tribal E communities • trategies for successful operational collaboration and mutual agreements between tribal S governments and nontribal public health emergency preparedness and response partners during public health emergency responses DATABASE SEARCH STRATEGIES Initial searches were run on December 3, 2018, covering 2001–December 2018. Final update searches were performed on June 5, 2019, covering December 2018–June 2019.
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.tw. 16 emergency preparedness/ or emergency response/ or emergency management/ 15,465 or disaster planning/ or disaster medicine/ or disaster resilience/ 17 or/13–16 230,361 18 12 or 17 241,051 19 Vulnerable Populations/ or Minority Groups/ or "Sexual and Gender Minorities"/ 4,051,798 or "Emigrants and Immigrants"/ or "Transients and Migrants"/ or African Americans/ or Hispanic Americans/ or Indians, North American/ or Asian Americans/ or Poverty/ or Socioeconomic Factors/ or "Aged, 80 and over"/ or Aged/ or INFANT/ or INFANT, NEWBORN/ 20 Pregnant Women/ or DIABETES MELLITUS/ or Heart Diseases/ or DEAF-BLIND 312,323 DISORDERS/ or BLINDNESS/ or Deafness/ or Persons With Hearing Impairments/ or Vision Disorders/ or Disabled Persons/ or Animal Assisted Therapy/ or Self Help Devices/ or Autistic Disorder/ 21 DEMENTIA/ or ANXIETY/ or ANXIETY DISORDERS/ or "Transportation of Patients"/ 1,835,230 or Homeless Persons/ or Rural Population/ or ELECTRICITY/ or CHILD/ or Health Literacy/ or Educational Status/ or Communication Barriers/
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" or "public health preparedness program* " or "school agenc*
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adj health adj 3,708 (department* or agenc*
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.tw. 15 epidemic/ or pandemic/ or disaster/ or mass disaster/ or nuclear terrorism/ 121,985 or terrorism/ or chemical terrorism/ or bioterrorism/ or disaster planning/ or disaster planning/ or disaster medicine/ 16 or/13–15 191,448 17 12 or 16 208,880 18 vulnerable population/ or minority group/ or "sexual and gender minority"/ or 995,819 undocumented immigrant/ or immigrant/ or migrant/ or African American/ or Hispanic/ or American Indian/ or Asian American/ or poverty/ or socioeconomics/ or very elderly/ or infant/ or newborn/ 19 pregnant woman/ or diabetes mellitus/ or heart disease/ or deafblindness/ or 728,645 blindness/ or hearing impairment/ or visual disorder/ or disabled person/ or animal assisted therapy/ or self help device/ or autism/ or mental deficiency/ 20 dementia/ or anxiety/ or anxiety disorder/ or patient transport/ or homeless 430,145 person/ or homeless man/ or homeless youth/ or homeless woman/ or rural population/ or electricity/ or health literacy/ or educational status/ or communication barrier/ 21 alcoholism/ or substance abuse/ or mental disease/ or alcoholism/ or drug abuse/ 468,019 or drug dependence/ or addiction/ or schizophrenia/ or psychosis/ 22 (vulnerable adj (population*
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2,259 44 ("C MIST" or "communication medical independence supervision transportation")
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) AND PUBYEAR AFT 2000 Exclude: Note, editorials, letters, and notes Results: 3,406 Emergency Operations Coordination Search Parameters: Date: 2001–Present Language: English Document Type: Exclude commentaries, editorials, letters, and notes Databases: Medline (Ovid)
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.tw. 16 emergency preparedness/ or emergency response/ or emergency management/ 15,465 or disaster planning/ or disaster medicine/ or disaster resilience/ 17 or/13–16 230,361 18 12 or 17 241,051 19 "emergency operations coordination".tw.
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adj warfare) or riot$ or influenza or flu or (civil adj 111,443 (disorder?
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.tw. 15 epidemic/ or pandemic/ or disaster/ or mass disaster/ or nuclear terrorism/ 138,280 or terrorism/ or chemical terrorism/ or bioterrorism/ or disaster planning/ or disaster planning/ or disaster medicine/ 16 or/13–15 221,710 17 12 or 16 241,171 18 "emergency operations coordination".tw.
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) AND PUBYEAR AFT 2000 Exclude: Editorials, letters, and notes Results: 2,813 Information Sharing Search Parameters: Date: 2001–Present Language: English Document Type: Exclude commentaries, editorials, letters, and notes Databases: Medline (Ovid)
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.tw. 16 emergency preparedness/ or emergency response/ or emergency management/ 15,465 or disaster planning/ or disaster medicine/ or disaster resilience/ 17 or/13–16 230,361 18 12 or 17 241,051 19 Health Personnel/ 35,245 20 Medical Staff/ or Public Health Administration/ 17,520 21 Emergency Responders/ or Emergency Medical Technicians/ 6,006 22 Physicians/ or Pharmacists/ or NURSES/ or Dental Staff/ or Nursing Staff/ or Local 156,181 Government/ or "Coroners and Medical Examiners"/ 23 (physician*
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".tw. 1,044 54 "community health information exchange".tw.
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adj health adj 4,481 (department* or agenc*
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284 EVIDENCE-BASED PRACTICE FOR PHEPR Search No. Syntax Results 23 pharmacist/ 68,847 24 nurse/ 108,515 25 dentist/ 21,686 26 coroner/ 2,341 27 (physician*
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10 65 or/40–64 659,896 66 17 and 39 and 65 3,673 67 limit 66 to (english language and yr="2001–Current") 3,230 68 limit 67 to (editorial or letter or note)
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adj health adj 3,961 (department* or agenc*
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adj warfare) or riot$ or influenza or flu or (civil adj 111,443 (disorder?
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adj health adj 4,481 (department* or agenc*
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Disaster Medicine and Public Health Preparedness 1(1)
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U.S. Preventive Services Task Force procedure manual.
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