Transcript Powerpoint

Emergency Management
Strategies for Identifying and
Integrating Community Resources
to Expand Medical Surge Capacity:
Role for Health Call Centers
Gregory M Bogdan, PhD
- Research Director & Medical Toxicology Coordinator
Rocky Mountain Poison & Drug Center – Denver Health
- Associate Professor, Dept. Pharmaceutical Sciences
University of Colorado Health Sciences Center
Challenges For Healthcare
• Lack of surge capacity in healthcare
systems
• Information and triage needs of “worried
well” and “walking wounded”
• Quarantine and isolation to halt spread of
disease
• Mass prophylaxis or immunization of
communities
• Pandemic or severe seasonal influenza
Estimates of Influenza Impact
Demands for health resources during a severe
influenza outbreak may cripple healthcare systems
Health Outcomes
Fatalities
Hospitalizations
15% Gross
35% Gross
Attack Rate* Attack Rate*
87,000
207,000
314,400
733,800
Outpatients Visit
18.1 million 42.2 million
Self-care Ill
21.3 million 49.7 million
* % US population with a clinical case of influenza
Challenges for Preparedness
• 2004 Redefining Readiness Project*
– 60% of public would not heed official instructions to get
vaccinated during smallpox outbreak
– 40% of public would not heed official instructions to shelter in
place during a dirty bomb incident
• Its not disregard for authority, but the need to obtain
additional information from a trusted source that would
limit public compliance with these directives
Need to educate, inform and support
what the public should do in an emergency
*R. Lasker, Center for the Advancement of Collaborative Strategies in Health
Public Does Rely Upon Call
Centers in Emergencies
25
20
Toronto lines received >300,000 calls with
daily peak of 47,567 calls (using >200 PH nurses)
15
10
5
0
Florida - Toronto Meningitis
SARS
Trenton Anthrax
NYC WNV
Colorado WNV
Certain events (bioterrorism, child-targeted, new emerging
disease) will effect the amount of public concern and numbers of
people having information or others needs.
How Can Call Centers Help?
Public Health/Safety agencies
announce health emergency
Uncontrolled
Messages
Controlled
Messages
Public will initially receive
information from the mass media
Information partners relay accurate,
up-to-date, consistent messages
and collect data from public
Poison Center
Nurse Line
Health Hot Line
Perhaps up to 25% of
the public will have
questions which call
centers can help with
1
2
3
“Tools” for Call Center Responses
Health Call Centers Reduce
Hospital Surges Everyday
• United States Poison Control Centers
– Of 2.4 million contacts about potential toxic
exposures each year, 1.8 million (75%) are
managed outside of health care facilities
• Denver Health NurseLine
– Manages 40% of callers at home
– Study: 70% of callers change their plans after
calling (most seek lower intensity of care than
originally planned: home > clinic > ED)
Health Emergency Line for the
Public (HELP) Model
• Standardized, prepared response to public health events:
 Providing consistent, accurate information
 Collecting and maintaining structured data to characterize events
and responses (for both sentinel events and situational awareness)
 Capability and capacity to adapt to other public health emergencies
(using technology & tools)
• Operating daily since 2003 (7a-10p) and has responded to
several major health events in Colorado
 Used in annual WNV & influenza responses (>80,000 calls)
 Collects data used for situational awareness (influenza, dead
animal, emerging disease reports)
 Model of poison center/public health partnership
HEALTH EMERGENCY LINE FOR THE PUBLIC
Hospitals &
Healthcare
Facilities
GOAL: “Preventing” Patient
Surges to Overwhelmed
Healthcare Agencies
Medical Evaluation &
Treatment
Referral of Screened Patients
For Triage & Evaluation
General
Public
Info
Request
Health
Professionals
GOAL: “Redirection” of
Contacts from Overwhelmed
Health Agencies
H
E
L
P
Health Information
Triage & Decision Support
Info
Delivery
Local & State
Public Health
Agencies
Disease Surveillance
Quarantine & Isolation Support
Outpatient Drug Info & Adverse Events
Real-Time Reporting of Collected
Epidemiologic Information
Epidemiologic Surveillance,
Investigation & Control
Measures, Prophylaxis
(Operational Model From an AHRQ Task Order)
HELP’s First Test - 2003
Jul 22: Colorado (4.4 million) confirms 1st human WNV
case, HELP launched just two hours prior
• HELP received 12,150 calls (Jul 22 - Oct 11) including
>2,500 dead bird reports (5 information providers)
• 60% of callers serviced with upfront messaging
• As of Oct 30: 47 deaths and 2,543 confirmed cases
[Toronto (4.6 million) SARS experience - 44 deaths and 438 SARS cases]
70%
60%
50%
40%
30%
20%
10%
0%
Smallpox
Flu/Pneumonia
West Nile Virus
Mold
Hantavirus
Tuberculosis
Our Experience Shows
• Need for and importance of providing
information and support to public (trust)
• Surveillance - not the original purpose of
line, became an important function (data)
• Structured hotline capabilities are an
important response component (capacity)
• Health call centers can and do serve a vital
role in response efforts (ready or not)
– Need tools and guidance for large events
Latest AHRQ Task Order
• Develop, implement and test a model to
adapt community health call centers to
support home management and shelterin-place approaches in certain mass
casualty or health emergency events
• Determined best DHS scenarios for such
strategies
DHS National Planning Scenarios
•
Strategies and tools were developed
specifically for 4 of the 15 scenarios:
•
•
•
•
Biological
Biological
Biological
Biological
Attack – Aerosol Anthrax
Disease Outbreak – Pandemic Influenza
Attack – Plague
Attack – Food Contamination
*Tools have wider applicability and can be
modified for other scenarios
*Dept of Transportation (EMS/911) and CDC
exploring call centers’ roles in pandemics
Response Model & Tools
• HELP Model (strategies & blueprint for
structured call center emergency response)
• Interactive Response (IR) Tools
– Quarantine & Isolation Monitoring (outbound)
– Zip Code Specific Messaging (inbound)
– Pill Identification/Information (inbound)
– FAQ Library (inbound)
Why Quarantine Monitoring?
• Taiwan - 131,132 people in quarantine
for SARS (10 to 14 days)
• Quarantine included limited travel and
health monitoring (primarily with inperson home visits, some phone calls)
COHELP
• 99% of those in quarantine did not
develop SARS and only needed
monitoring
• Call center
• Periodic checks
Patient list,
contact
numbers
provided by
Health Dept
Quarantine
Patients
Call is
answered
YES
Press 1 for
English
NO
Press 2 for
Spanish
First Unsuccessful
Attempt
This is the Colorado Help
Line. If you need
assistance and would like
to speak to someone,
press 0. If you do not need
assistance, press 1
1
• Referral to other sources if
symptoms develop.
Calls are
delivered at
random times
each day x2
IVR System
0
Thank you. If you need
assistance in the
future, please call….
Give info per
FAQ’s
Second
Unsuccessful
Attempt
Information Provider
answers call.
How may I help you?
Request for
information
Request for
assistance or
requested information
not in FAQ
Public Health
Notified
We will call
you back in ….
Request goes to Public
Health or other
appropriate resource per
protocols
But Will It Be Acceptable in US?
Harvard School of Public Health Survey revealed that:
• 76% favor quarantine of people suspected of having been
exposed to a serious contagious disease
 29% no longer favor if people are arrested for refusing
• 75% favor use of periodic telephone calls to monitor
quarantined people (84% favor daily visits)
43% guards, 40% e-bracelets, 31% periodic video screening
• 70% prefer they or family member be quarantined at home
These factors suggest quarantine monitoring by call centers
is good strategy for disease control/containment
Blendon RJ et al. Attitudes Toward The Use Of Quarantine In A Public Health Emergency In Four
Countries. Health Affairs 2006; 25:w15-w25.
Why this response capability?
 Public health events will continue to occur and
will require coordinated responses to protect
our healthcare systems
 Need structured, integrated responses that are:
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
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
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Cost-effective
Efficient (use of staff and technology)
Accurate
Consistent
Adaptable
 Health call centers can fill a vital role in
providing information, collecting surveillance
data and monitoring/supporting home care
strategies
Summary
• Health call centers already exist within
communities and should be considered/integrated
as part of emergency response strategies
 Health Call Centers can:



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Improve information support for public and providers
Assist with surge capacity
Provide surveillance signals, situational data
Realize the new Public Health environment
 Increase visibility (extend response capabilities outside of Mon
to Fri 8 am to 5 pm period, improve access)
 Handle evolving info while maintaining control (assist with info
management, improve dissemination)
 Aid decision support (assist with healthcare utilization)
Further Information
For inquiries regarding presentation:
Gregory M. Bogdan, PhD
Rocky Mountain Poison & Drug Center – Denver Health
777 Bannock St, Mail Code 0180
Denver CO 80204
303-739-1239
[email protected]
For additional info on AHRQ task orders:
“Health Emergency Assistance Line and Triage Hub
(HEALTH) Model” - www.ahrq.gov/research/health/
“Adapting Community Call Centers for Crisis Support: A
Model for Home-Based Care and Monitoring” www.ahrq.gov/prep/callcenters/