Evidence-Based Practice for Public Health Emergency Preparedness and Response (2020) / Chapter Skim
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Pages 5-22
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From page 5... ...
Yet, the existing scientific evidence base that informs the actions of SLTT public health agencies in preparing for and responding to these emergencies is sparse and uneven, and fails to meet the needs of public health emergency preparedness and response (PHEPR) practitioners for clear and accessible guidance.
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From page 6... ...
For the four selected PHEPR practices reviewed by the committee, evidence-based practice recommendations and implementation guidance are presented in Chapters 4–7, respectively. These four chapters are oriented to practitioners and include high-level evidence summaries for the four PHEPR practices; each of these chapters opens with a two-page action sheet pro 2 In PHEPR, in contrast to clinical medicine, there is seldom a discrete "intervention"; therefore, the committee defined PHEPR practice broadly as a type of process, structure, or intervention whose implementation is intended to mitigate the adverse effects resulting from a public health emergency on the population as a whole or a particular sub-group within the population.
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From page 7... ...
IMPROVING AND EXPANDING THE EVIDENCE BASE FOR PHEPR State of the Evidence and Underlying Reasons The findings from the committee's four PHEPR practice evidence reviews (described below) and a broader scoping review of the evidence for the PHEPR Capabilities (discussed in Chapter 2)
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From page 8... ...
. Through the development of such a national framework, the com Robust and sustained Recognition of PHEPR commitment to PHEPR science as a unique researcher and practitioner academic discipline within training and education public health PHEPR evidence-based Capacity building for guidelines group to translation, develop guidelines for dissemination, and PHEPR practice and implementation of communicate key research to practice evidence gaps System leadership to transform how PHEPR research is coordinated, sustainably funded, and conducted Cross-cutting, forward-looking Common evidence research agenda with a focus guidelines and standards on innovation and with a focus on rigorous systems-level approaches research and evaluation Mechanisms to build and maintain durable and trusting partnerships among practitioners, communities, and researchers FIGURE S-1 Key components of a National PHEPR Science Framework.
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From page 9... ...
RECOMMENDATION 3: Develop a National Public Health Emergency Preparedness and Response (PHEPR) Science Framework To enhance and expand the evidence base for PHEPR practices and translation of the science to the practice community, the Centers for Disease Control and Prevention should work with other relevant funding agencies; state, local, tribal, and territorial public health agencies; academic researchers; professional associations; and other stake holders to develop a National PHEPR Science Framework so as to ensure resourcing, coordination, monitoring, and execution of public- and private-sector PHEPR research.
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From page 10... ...
. Supporting Methodological Improvements to PHEPR Research and Practice Evaluation Improving and expanding the evidence base as envisioned through the proposed National PHEPR Science Framework will require incentives for PHEPR researchers and practitioners.
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From page 11... ...
can inform why and how PHEPR practices may or may not be effective, which may help explain study results or inform intervention design, and can also be useful in generating theories that can be tested empirically. As PHEPR research is transdisciplinary, design methodologies used in such fields as public health services and systems research, operations research, organizational research, and quality improvement can also provide evidence for understanding PHEPR practices.
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From page 12... ...
. Training and Supporting the PHEPR Practitioner and Researcher Workforce Expanding and improving the PHEPR evidence base will depend on developing and supporting PHEPR researchers and practitioners with the skills necessary to ensure the conduct of quality PHEPR research and program evaluation, respectively, and on strengthening 4 AARs are documents created by public health authorities and other response organizations following an emergency or exercise, primarily for the purposes of quality improvement.
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From page 13... ...
and the Office of the Assistant Secretary for Preparedness and Response should work with professional and academic organizations that represent multiple disciplines to guide and support the creation of the workforce capacity development and technical assistance programs necessary to ensure the conduct of quality PHEPR research and evaluation and improve the implementation capacity of state, local, tribal, and territorial public health agencies. Such efforts should include • eveloping a research training infrastructure and career development grants -- d institutional and individual predoctoral, postdoctoral, loan repayment, and career awards -- to develop and support researchers in PHEPR in order to address research gaps in the field; • providing training grants so that PHEPR researcher and practitioner teams can learn how to develop PHEPR practices that are grounded in science and theory and to evaluate the effectiveness and implementation of PHEPR practices using rigorous and appropriate designs; • roviding ongoing technical assistance and peer networking for both PHEPR p researchers and practitioners; and • creating a training and certification program for CDC project officers and state pre paredness directors to ensure their familiarity with evidence-based practices and promote consistent creation and evaluation of real-world evidence as captured in after action reports.
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From page 14... ...
The PHEPR system draws on a broad evidence base, ranging from randomized controlled trials to surveys, modeling studies, and AARs, and the committee's methodology needed to accommodate that diversity. In addition to both quantitative and qualitative research-based evidence, the approach makes use of experiential evidence from 5 The committee held a 1-day public workshop on evidence evaluation frameworks used in health and nonhealth fields, which is documented separately in a Proceedings of a Workshop -- in Brief (see Appendix E)
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From page 15... ...
The practice selection criteria, therefore, were developed with the aim of yielding a set of PHEPR practices that would be diverse with respect to both the research and evaluation methodologies used to generate the evidence base for them and their characteristics, such as the type and scope of event in which a practice is implemented, the practice setting, whether the practice is complex or simple, whether it is within the direct purview of public health agencies, and whether it is preparedness or response oriented. This process was intended to result in a methodology that would be applicable across the full range of PHEPR practices.
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From page 17... ...
AAR = after action report; CERQual = Confidence in the Evidence from Reviews of Qualitative Research; COE = certainty of the evidence; GRADE = Grading of Recommendations Assessment, Devel pment and Evaluation; PHEPR = public health o emergency preparedness and response.
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From page 18... ...
Despite the limitations of the evidence base -- which was often sparse and characterized by a predominance of descriptive reports and studies with notable shortcomings in their design or conduct -- and challenges in the application of GRADE to practices that are dependent on context and implementation fidelity, the committee's mixed-method, layering approach enabled the development of practice recommendations for three of the four review topics. For the fourth topic (activating a public health emergency operations center)
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From page 19... ...
The practice should be emergency guidance to technical audiences during a accompanied by targeted monitoring and public health emergency to increase awareness evaluation or conducted in the context of and appropriate guidance use have differing research when feasible so as to improve impacts. However, the available data are the evidence base for strategies used to insufficient to support a conclusion as to communicate public health alerts and what technology is best for which audiences guidance to technical audiences.
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From page 20... ...
In addition to guiding PHEPR practice and decision making, such a mechanism has the potential to drive improvements in the evidence base over time and guide the research agenda through the identification of evidence gaps. Given the complexity of the committee's review methodology, the implications for the multidisciplinary group of experts who will need to be involved in future reviews, and the importance of practice guidelines being issued by an authoritative source with the trust of the PHEPR community and the ability to disseminate this guidance widely, the committee concludes that a centralized approach supported by CDC is the best model for a process for ongoing evidence reviews of PHEPR practices.
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From page 21... ...
should use a coordinated imple mentation science approach to ensure that the evidence-based practice recommenda tions resulting from the PHEPR evidence-based guidelines group proposed in Recom mendation 1 achieve broad reach and become the standard of practice of the target audience. Strategies to this end include • ncorporating evidence-based practices into the Public Health Emergency Pre i paredness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health guidance document; • building evidence-based practices into the design of and funding decisions for the Public Health Emergency Preparedness Cooperative Agreement program; • incentivizing and requiring state, local, tribal, and territorial public health agencies to test and evaluate new or adapted practices and embed program evaluations into routine operations to help better understand whether evidence-based practices worked, under what conditions, with what impacts and consequences, and at what cost;
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From page 22... ...
As this report demonstrates, it is clear that, while challenging, strategies exist for remedying the lack of an established scientific evidence base in the PHEPR field. As the PHEPR research field continues to evolve and mature, it is the committee's assertion that such an evidence base represents the essential foundation of future policy and practice changes.
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