The ability to notify and assemble staff quickly in order to begin the decision-making process is critical when faced with a public health emergency. This study examined state infrastructure factors that affect response time during a public health incident, specifically, the effect of federal public health emergency preparedness (PHEP) funding and state governance structure on staff response time.
A retrospective cross-sectional mixed methods study design utilized data from the Centers for Disease Control and Prevention's (CDC) Preparedness Emergency Response System for Oversight, Reporting and Management Services (PERFORMS) and the Association of State and Territorial Health Officials (ASTHO) for all 50 states between 2007 and 2010. After removing outliers, PHEP funding did not significantly reduce response time for staff notifications R = -.008, F(1,577) = .039, p = .422 or staff assemblies R = -.039, F( 1,441) = .661, p = .208. However, the type of state governance structure significantly reduced response time for staff notifications t(577) = -2.02, p = .022 and staff assemblies t(441) = -2.96, p = .02. States with a centralized form of governance structure took longer to notify (M = 23.44 minutes vs. M = 27.54 minutes) and to assemble staff (M = 32.36 minutes vs. M = 41.74 minutes). The number of staff responding, the type of incident, whether the incident was announced or unannounced and whether the incident was during normal business hours or outside normal business hours did not explain the observed response time.
For states that exceeded CDC-recommended response times, qualitative analysis identified barriers to a timely response. Three themes emerged: staff, the organization and channels of communication. Barriers related to the organization and channels of communication were identified and reduced or eliminated over time. Barriers related to staff were ongoing and hard to reduce or eliminate.
Changes in the survey questionnaire in 2009 and the addition of two survey modules had a negative effect on mean response times and response rates. State governance structure, increased reporting burden and staff burnout may explain some of the lack of improvement in response time over the four year study period.
|Commitee:||Rangel, Maria C., Thomas, Craig W.|
|School:||Central Michigan University|
|Department:||DHA - Health Administration/School of Health Sciences|
|School Location:||United States -- Michigan|
|Source:||DAI-B 74/03(E), Dissertation Abstracts International|
|Keywords:||Disasters, Emergency management, Emergency preparedness, Public health, Response time, State governance structure|
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