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Survey Detects Variations In Response Speed Among
Public Health Agencies, Despite Federal Guidelines

Researchers Find Public Health Officials Sometimes Miss Deadlines
For Responding To Urgent Reports, Raising Questions About Quality

BETHESDA, MD —Local public health agencies’ responses to urgent infectious disease reports vary substantially across the country, despite federal government guidelines that call for agencies to have around-the-clock ability to receive reports and a thirty-minute response time, according to a new report published today on the Health Affairs Web site.

The survey of nineteen local public health agencies in eighteen states — representing all parts of the country, as well as urban and rural regions — showed response times ranging from less than a minute to more than 40 hours to six to ten test calls placed during daytime, nighttime and weekend hours, according to David Dausey, an associate policy researcher at RAND Corporation in Pittsburgh, and two colleagues.

The goal of the calls was to reach an “action officer,” a public health official responsible for responding to urgent case reports.

The average response time was 55 minutes. Eight of the nineteen agencies returned all calls within thirty minutes, a response time that meets guidelines set by the U.S. Centers for Disease Control and Prevention. The longest average response times were at the end of a workday (99 minutes), during the evening (61 minutes), and on weekends (102 minutes). Four of the agencies failed to return one or more of the calls.

The share of calls handled with “warm transfers” — that is, transfers directly to the action officer — ranged from 25 to 100 percent. Agencies that handled calls with warm transfers more frequently met the standard of responding within thirty minutes.

“In the U.S. health care system, large variations in use or procedures raise questions about quality, efficiency, and safety,” Dausey says. “In public health systems, such variations ought to raise similar concerns.

“They may also reflect the multi-tier, complex organizational arrangements under which local public health agencies operate,” he says. “For example, in some states, public health is highly centralized, while in others, local public health agencies operate under home rule. Such variation thwarts attempts to standardize protocols and procedures and raises the likelihood that there will be delays or errors in reporting, outbreak detection, and disease control. It also calls into question the purported ability of the U.S. public health system overall to mount a consistent, concerted surveillance effort or respond to mass threats.”

The article does not identify the agencies by name. In each case, the director of the agency agreed to take part in the test, but no other personnel were notified. After the testing was completed, each director received a summary of their agency’s performance, along with a deidentified information on the performance of the other agencies.

Dausey’s colleagues were Nicole Lurie, senior natural scientist and the Paul O’Neill Alcoa Professor at RAND in Arlington, Virginia; and Alexis Diamond, a doctoral candidate at the Center for Basic Research in Social Sciences at Harvard University. The research was supported by a grant from the U.S. Department of Health and Human Services.

The article can be read at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.412.


Health Affairs , published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.

©2005 Project HOPE–The People-to-People Health Foundation, Inc.