Our research team at Stanford University, Battelle Memorial Institute, and the University of California at Davis (UC-Davis), under contract with the Agency for Healthcare Research and Quality (AHRQ) and in assistance to the Assistant Secretary for Preparedness and Response (ASPR), is developing a set of indicators for hospital emergency preparedness. Building on expertise in health care quality indicator development, our research team is striving to extend the concept of evidence-based measures to the field of healthcare emergency preparedness. We are working toward identifying a set of scientifically feasible, valid, and reliable measures of the healthcare system's ability to respond in the event of a mass-casualty medical emergency. The initial project will focus on hospital preparedness and measures will be reported on a statewide level. These measures will be part of a toolkit for decision-makers at the state and national level to assist in the planning for an emergency and will be used in an annual congressional report.
Project Scope and Methodology
Indicator development will progress in two phases. First, we will identify candidate indicators from existing sources, and summarize existing evidence. Building on this work, we will identify the indicators with the most available supporting evidence. In the second phase, we will extend the evidence in validation studies.
Our team will identify candidate indicators through literature review (both peer reviewed and grey), guidelines, the Internet, and other sources as needed. In addition, we will solicit information from relevant organizations, such as clinical professional groups, accreditation bodies, and federal agencies, in order to identify ongoing work in hospital emergency preparedness in which they are engaging.
Following the identification of candidate measures, we will review and summarize the literature and supporting evidence for the measures, including feasibility and scientific soundness. Further, panels composed of clinicians and other professionals involved in hospital emergency response will evaluate the indicators. These panels will serve to establish the face validity of the indicators, provide important guidance on the caveats of the indicators, and aid in honing indicator definitions. Nominees for panels will be obtained from national professional organizations. Upon analyzing the panel findings, we will draft a technical report outlining the results of our process and will move forward toward implementation of the measures.
The second phase of the project aims to validate and implement the emergency preparedness measures that are identified and researched in the first phase. The team will pilot-test the measures and conduct empirical analyses to develop and assess potential definitions. Following this process, the most promising measures will be identified and recommended for implementation.
We are currently identifying and compiling potential measures from a wide range of sources, including those from the U.S. Department of Homeland Security, the U.S. Department of Health and Human Services and its affiliates, the U.S. Department of Veterans Affairs, the U.S. Department of Labor, Occupational Safety and Health Administration, the U.S. Government Accountability Office, the Joint Commission on Accreditation of Healthcare Organizations, sub-national government institutions, professional organizations, and international reports. We understand that the scope of emergency preparedness is widely thought to encompass a number of framework areas. With this in mind, we are considering measures that address many of these areas: surge capacity and alternate care sites, emergency management procedures and plans, communications systems, decontamination, evacuation and shelter-in-place, security, disease reporting and surveillance, countermeasures and personal protective equipment, behavioral health, fatality management, volunteer and personnel management, staff training, patient management, and community integration.