NHSPI_measure_metadata
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| Link | rowid ▼ | obsid | index | item_code | domain_code | domain_name | domain_description | subdomain_code | subdomain_name | subdomain_description | subdomain_long_desc | measure_name | measure_description | measure_rationale | data_source | verbose_data_source | data_dates | limitations |
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| 1 | 1 | 3.0 | Foundational | 1.1.1 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M17 | State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS) | The measure indicates participation in the nation's largest surveillance system that tracks health conditions and risk behaviors. The Behavioral Risk Factor Surveillance System (BRFSS) is used to collect prevalence data from U.S. adult residents regarding risk behavior and preventive health practices that can affect health status. Participation can provide population-level data that can be useful in vulnerability assessments and developing messaging and intervention strategies. | CDC BRFSS | Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors. | 2012—2015 | The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states. |
| 2 | 2 | 4.0 | Index | 1.1.2 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M18 | Number of epidemiologists per 100,000 population in the state, by quintile (1=Lowest Quintile, 5=Highest Quintile) | The measure indicates the state-wide personnel capacity of epidemiologists. An accessible epidemiology workforce is critical to assuring an organization can maintain on-going surveillance operations to detect emerging disease and to surge, or ramp up, during and after any significant event involving exposure to a hazard. | BLS OES & ASTHO | Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction | 2012—2017 | The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error. |
| 3 | 3 | 5.0 | Foundational | 1.1.3 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M19 | State health department participates in the Epidemic Information Exchange (Epi-X) System | The measure indicates participation in the Centers for Disease Control and Prevention (CDC)-sponsored national information sharing system. Participation in this system provides access to national level alerts and raises situational awareness beyond state borders. | CDC Epi-X | Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program | 2013 | The measure does not evaluate the quality or comprehensiveness of state participation in the system. |
| 4 | 4 | 6.0 | Foundational | 1.1.4 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M20 | State health department participates in the National Electronic Disease Surveillance System (NEDSS) | The measure indicates participation in the national, electronic public health surveillance system. Participation assures that key surveillance data are comparable across states and enables national measurements of disease burden and progression. | CDC NEDSS | Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS) | 2013—2015 | The measure does not evaluate the quality or comprehensiveness of state participation in the system. |
| 5 | 5 | 7.0 | Index | 1.1.5 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M22 | State health department has an electronic syndromic surveillance system that can report and exchange information | The measure indicates state health department-access to syndromic surveillance data. Syndromic surveillance enables continuous monitoring for indicators of population level changes in health status that can in turn provide early warning of hazardous events. | ASTHO Profile V. III | Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three | 2012 & 2016 | Data are self-reported by state public health agencypersonnel and may reflect differences in awareness, perspective and interpretation among respondents. Nevada did not complete the survey used as the original data source but they subsequently provided information for this measure. |
| 6 | 6 | 8.0 | Index | 1.1.6 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M217 | State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies | Laboratory Information Management Systems (LIMS) are important contributors to timely and accurate sending and receiving of critical laboratory testing information. | APHL CLSS | Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS) | 2012, 2014, & 2016 | Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the all years of survey have been corrected for Wyoming and 2016 fresponse for Oklahoma has been corrected and therefore no longer correspond to the originally published survey results. |
| 7 | 7 | 9.0 | Index | 1.1.7 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M220 | State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory | States and the federal government have disease reporting regulations that require notification of foodborne and other infectious diseases. Reporting requirements provide population-based data on infectious diseases. | APHL CLSS | Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS) | 2012, 2014, & 2016 | Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results. |
| 8 | 8 | 10.0 | Foundational | 1.1.8 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M256 | State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet) | The measure indicates participation in national information sharing systems and electronic web-based public health surveillance systems. Participation assures that laboratory and surveillance data are comparable across states and enables national measurements of disease burden and progression. | APHL CLSS | Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS) | 2012 & 2014 | The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks. |
| 9 | 9 | 11.0 | Index | 1.1.9 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M23 | Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed | The measure indicates a state's ability to confirm the pathogens that cause foodborne disease outbreaks. This capability allows states to identify and intervene rapidly to prevent further spread of outbreaks in the community. | CDC NORS | Centers for Disease Control and Prevention (CDC), National Outbreak Reporting System (NORS) | 2012—2017 | The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks. |
| 10 | 10 | 12.0 | Foundational | 1.1.10 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M289 | State health department participates in a broad prevention collaborative addressing healthcare-associated infections (HAIs) | Healthcare-associated infections (HAIs) are diseases acquired by patients while receiving medical treatment in a healthcare facility. HAIs are significant sources of preventable disease burden, and place communities at elevated risk of large-scale outbreaks and epidemics. State prevention collaboratives consist of multiple hospitals within a state that support implementation of evidence-based prevention strategies through peer learning, performance measurement, and feedback reporting to clinicians and staff. State health department participation in these collaboratives is an indicator of the strength of HAI prevention strategies. | CDC PSR | Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports | 2013 | The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives. |
| 11 | 11 | 13.0 | Index | 1.1.11 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M290 | State has a public health veterinarian | This measure indicates a state’s ability to access veterinarian expertise in preventing, preparing for, detecting, responding to, and recovering from hazardous events that may originate in or spread through animal populations, ultimately creating health risks for humans. | NASPHV | National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians | 2014 & 2015, 2017—2019 | The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation. |
| 12 | 12 | 14.0 | Index | 1.1.12 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M265 | State uses an Electronic Death Registration System (EDRS) | The measure indicates a state's adoption and use of an electronic death registration system (EDRS). This capability may reduce the time require to process and access death certificates during an emergency. | NAPHSIS | National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State) | 2014—2018 | The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages. |
| 13 | 13 | 15.0 | Foundational | 1.1.13 | 1.0 | HSS | Health Security Surveillance | 1.0 | PHSEI | Health Surveillance & Epidemiological Investigation | The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance. | M801 | State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network | The measure indicates state participation in national information sharing systems and electronic web-based public health surveillance systems for influenza. Participation assures that key laboratory and surveillance data will be comparable across states and enables national and global measurements of disease burden and progression.. | APHL CLSS | Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS) | 2012 & 2014 | The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks. |
| 14 | 14 | 17.0 | Foundational | 1.2.1 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M1 | Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise | The measure focuses on laboratory knowledge, skills, and abilities to follow federal packaging and shipping regulations and the Centers for Disease Control and Prevention's (CDC) Laboratory Response Network (LRN) protocols. | CDC Snapshot | Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness | 2011—2013 | The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times. |
| 15 | 15 | 18.0 | Index | 1.2.2 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M1314 | State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA) | A laboratory must have federal certification to conduct testing for chemical agents. The measure focuses on certification or accreditation of a chemical laboratory. Also, a relevant certification framework exists for radiological terrorism laboratory certification. The measure also indicates whether a state's radiological terrorism laboratory has earned such certification. | APHL AHLPS | Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey | 2013—2018 | Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results |
| 16 | 16 | 21.0 | Index | 1.2.6 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M208 | State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service) | The laboratory must have a federal U.S. Department of Agriculture/Animal and Plant Inspection Service (USDA/APHIS) permit for the importation and transportation of controlled materials. The measure focuses on possession of the permit. | APHL CLSS | Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS) | 2012, 2014, & 2016 | Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. |
| 17 | 17 | 22.0 | Index | 1.2.7 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M8 | State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1) | The measure focuses on the state public health laboratory workforce readiness and surge capacity. | APHL AHLPS | Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey | 2013—2018 | The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested. |
| 18 | 18 | 23.0 | Index | 1.2.8 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M9 | State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines | The measure focuses on laboratory preparedness to sustain operations and provide alternative methods for operations during a public health emergency that directly impacts the laboratory staff or facility. | APHL AHLPS | Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey | 2013—2018 | The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested. |
| 19 | 19 | 24.0 | Index | 1.2.9 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M11 | State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours | The measure focuses on a public health laboratory's ability to receive samples at all times of the day from healthcare laboratories. It demonstrates that the public health laboratory is capable of receiving critical specimens during nonbusiness hours. | APHL AHLPS | Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey | 2013—2018 | The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested. |
| 20 | 20 | 25.0 | Index | 1.2.10 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M12 | State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory | Rapid transport of specimens and isolates to a public health laboratory is important to decrease the time to recognize and identify a potential public health emergency. The measure focuses on a laboratory's ability to assure transport of samples at all times of the day. | APHL AHLPS | Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey | 2013—2018 | The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state. |
| 21 | 21 | 26.0 | Index | 1.2.11 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M211 | Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella | The measure focuses on the public health laboratory's (PHL's) ability to provide a range of diagnostic and surveillance testing. | APHL CLSS | Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS) | 2012, 2014, & 2016 | The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for Louisana and therefore no longer correspond to the originally published survey results. |
| 22 | 22 | 27.0 | Index | 1.2.12 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M216 | Percent of 15 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin—mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies | The measure focuses on the public health laboratory's (PHL's) ability to provide a range of diagnostic and surveillance testing. | APHL CLSS | Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS) | 2012, 2014, & 2016 | The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results. |
| 23 | 23 | 30.0 | Index | 1.2.15 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M2 | Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories | Recognition of a health emergency requires accurate and timely laboratory testing of a variety of samples in order to detect potential diseases or exposures. The measure focuses on the ability of lab to detect and identify biological threat agents in an exercise or test scenario. | CDC Snapshot | Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness | 2011—2016 | Laboratories may not undergo proficiency testing for all assay capabilities. Selected responses from the 2013, 2014, 2015, and 2016 survey have been corrected for Louisana and therefore no longer correspond to the originally published survey results. |
| 24 | 24 | 31.0 | Index | 1.2.16 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M3 | Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories | Bacterial subtyping data can be important in outbreak detection. The measure focuses on the timeliness of the public health laboratory to perform subtyping tests and report results nationally. | CDC Snapshot | Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness | 2011—2016 | The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping. |
| 25 | 25 | 32.0 | Index | 1.2.17 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M5 | Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state’s Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise | The measure focuses on a public health laboratory's ability to perform, without notice, tests on patient specimens for chemical agents and report the results. | CDC Snapshot | Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness | 2013—2016 | The measure does not consider the public health laboratory's ability to process a large number of samples. |
| 26 | 26 | 34.0 | Index | 1.2.19 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M7 | Number of additional chemical agent detection methods—beyond the core methods—demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state | Recognition of a health emergency requires accurate and timely laboratory testing of a variety of samples in order to detect potential diseases or exposures. The measure focuses on the ability of a laboratory to detect and identify chemical threat agents during an exercise or test. | CDC Snapshot | Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness | 2011—2016 | The measure does not consider all methods that the laboratory is capable of testing. |
| 27 | 27 | 36.0 | Index | 1.2.21 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M286 | Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually | Drills and exercises are important to the development and improvement of emergency preparedness and response plans and procedures. Frequent testing of plans and updated plans are important to continuous quality improvement. | APHL AHLPS | Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey | 2013—2018 | Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. |
| 28 | 28 | 37.0 | Index | 1.2.22 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M287 | Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories | Rapid identification of Listeria moncytogenes at the state's PFGE laboratory and rapid submission of the results to the Pulsenet national database is important to be able to identify multistate or national outbreaks of diseases. Once outbreaks are identified and the source is investigated, recalls and advisories can be issued to protect the public from additional exposure. | CDC Snapshot | Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness | 2011—2016 | The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification. |
| 29 | 29 | 38.0 | Index | 1.2.23 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M288 | Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state | The Centers for Disease Control and Prevention (CDC) identified nine core methods for detecting and measuring chemical agents, and conducted testing to determine LRN-C laboratories' proficiency in these methods. The core methods are significant as they use technical fundamentals that provide the foundation of chemical analysis capabilities. | CDC Snapshot | Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness | 2011—2016 | The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and Louisana and therefore no longer correspond to the originally published results. |
| 30 | 30 | 38.1 | Index | 1.2.24 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M911 | State public health laboratory provides or assures testing for soil | Soil testing is an essential component of environmental monitoring. | APHL CLSS | Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source. | 2012, 2014, & 2016 | The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results. |
| 31 | 31 | 38.2 | Index | 1.2.25 | 1.0 | HSS | Health Security Surveillance | 2.0 | BMLT | Biological Monitoring & Laboratory Testing | The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing. | M902 | State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory) | Level 2 laboratories are staffed with chemists who are trained to detect exposure to a broad array of chemical agents. Level 1 laboratories provide surge-capacity testing for federal CDC laboratories and are able to detect exposure to an expanded number of chemical agents beyond the Level 1 testing capabilities. State participation in LRN-C may enable faster detection of chemical exposures that are of public health concern. | CDC NCEH/DLS/ERB | Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB) | 2016 & 2017 | The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities. |
| 32 | 32 | 42.0 | Index | 2.1.2 | 2.0 | CPE | Community Planning & Engagement Coordination | 3.0 | CSCC | Cross-Sector / Community Collaboration | The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services. | M87 | State health department is accredited by the Public Health Accreditation Board (PHAB) | The measure indicates state health department conformance with national standards that support continuous improvements in the implementation of public health programs and policies. | PHAB | Public Health Accreditation Board (PHAB), Health Departments in e-PHAB | 2013—2018 | The measure does not reflect health departments that are in process of achieving accreditation. |
| 33 | 33 | 48.0 | Index | 2.1.8 | 2.0 | CPE | Community Planning & Engagement Coordination | 3.0 | CSCC | Cross-Sector / Community Collaboration | The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services. | M501 | Percent of the state’s population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems | Inter‐organizational connectedness can be an indicator of community resilience. | NLSPHS | National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel. | 2012, 2014 & 2016 | Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents. |
| 34 | 34 | 48.1 | Index | 2.1.9 | 2.0 | CPE | Community Planning & Engagement Coordination | 3.0 | CSCC | Cross-Sector / Community Collaboration | The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services. | M9031 | Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response | Broad participation in Health Care Coalitions may enhance communication, resource-sharing, and coordinated planning and response activities across sectors in the event of an emergency. | HHS ASPR | Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services | 2013—2017 | The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions. |
| 35 | 35 | 48.2 | Index | 2.1.10 | 2.0 | CPE | Community Planning & Engagement Coordination | 3.0 | CSCC | Cross-Sector / Community Collaboration | The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services. | M9032 | Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response | Broad participation in Health Care Coalitions may enhance communication, resource-sharing, and coordinated planning and response activities across sectors in the event of an emergency. | HHS ASPR | Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services | 2013—2017 | The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions. |
| 36 | 36 | 48.3 | Index | 2.1.11 | 2.0 | CPE | Community Planning & Engagement Coordination | 3.0 | CSCC | Cross-Sector / Community Collaboration | The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services. | M9033 | Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response | Broad participation in Health Care Coalitions may enhance communication, resource-sharing, and coordinated planning and response activities across sectors in the event of an emergency. | HHS ASPR | Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services | 2013—2017 | The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions. |
| 37 | 37 | 48.4 | Index | 2.1.12 | 2.0 | CPE | Community Planning & Engagement Coordination | 3.0 | CSCC | Cross-Sector / Community Collaboration | The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services. | M9034 | Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response | Broad participation in Health Care Coalitions may enhance communication, resource-sharing, and coordinated planning and response activities across sectors in the event of an emergency. | HHS ASPR | Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services | 2013—2017 | The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions. |
| 38 | 38 | 56.0 | Index | 2.2.7 | 2.0 | CPE | Community Planning & Engagement Coordination | 4.0 | ARP | Children & Other At-Risk Populations | Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation. | M163 | Number of pediatricians per 100,000 population under 18 years old in the state | Pediatricians are specially trained to provide medical care to children. These skills are particularly needed to provide care to children that have serious injuries or illnesses associated with mass casualty events and disease outbreaks. The measure focuses on the state's workforce capacity of pediatricians capable of providing specialized children's medical care. | AHRF | U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF) | 2010, 2015-2016 | The measure does not consider mutual aid plans that may be in place for healthcare facilities to supplement the number of available pediatricians in the event of an emergency. |
| 39 | 39 | 57.0 | Index | 2.2.8 | 2.0 | CPE | Community Planning & Engagement Coordination | 4.0 | ARP | Children & Other At-Risk Populations | Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation. | M164 | Number of obstetricians and gynecologists per 100,000 female population in the state | Obstetricians and gynecologists are specially trained to provide medical care to women, including during and after pregnancy. These skills are particularly needed to provide care to women who have serious injuries or illness associated with mass casualty events and disease outbreaks. The measure indicates a state's capacity to provide specialized women’s health services during emergencies and in routine care situations. | AHRF | U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF) | 2010, 2015-2016 | The measure does not consider mutual aid plans that may be in place for healthcare facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency. |
| 40 | 40 | 58.0 | Index | 2.2.9 | 2.0 | CPE | Community Planning & Engagement Coordination | 4.0 | ARP | Children & Other At-Risk Populations | Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation. | M170 | Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers | Treatment of traumatic injury among children requires timely access to specialized skills and resources. The measure indicates medical infrastructure and, by inference, trained staff capable of providing specialized care to pediatric trauma patients. | AHA | American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel. | 2012—2017 | The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients. |
| 41 | 41 | 70.1 | Index | 2.2.21 | 2.0 | CPE | Community Planning & Engagement Coordination | 4.0 | ARP | Children & Other At-Risk Populations | Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation. | M53B | Percent of youth who did not miss one or more days of school in past month due to concerns about safety | School safety practices can reduce student concerns about safety and improve student adherence to emergency plans and protocols. | CDC YRBS | Youth Risk Behavior Survey | 2011, 2013, 2015 & 2017 | The measure is self-reported and does not distinguish reasons for safety concerns. |
| 42 | 42 | 71.0 | Foundational | 2.3.1 | 2.0 | CPE | Community Planning & Engagement Coordination | 5.0 | MVDE | Management of Volunteers during Emergencies | The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance | M36 | State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry | The measure indicates participation in a standard national system to verify emergency volunteers and credentials through preregistration before an emergency occurs. | ASPR ESAR-VHP | Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) | 2014 | The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies. |
| 43 | 43 | 72.0 | Index | 2.3.2 | 2.0 | CPE | Community Planning & Engagement Coordination | 5.0 | MVDE | Management of Volunteers during Emergencies | The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance | M266 | Percent of the state’s population who live in a county with a Community Emergency Response Teams (CERT) | Citizen Corps is a U.S. Department of Homeland Security initiative coordinated through the Federal Emergency Management Administration (FEMA) to engage, educate, and train volunteers to strengthen personal and community preparedness and response. Launched in 2002, Citizen Corps comprises a network of more than 1,200 county, tribal, state, and territorial councils and 2,400 registered Community Emergency Response Teams (CERT), which have completed specialized training. Citizen Corps has partner programs, which include Fire Corps (through FEMA and the National Volunteer Fire Council) and Volunteers in Police Service (through the International Association of Chiefs of Police). | FEMA & CC CERT | Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel. | 2012—2014, 2016 | The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors. |
| 44 | 44 | 73.0 | Index | 2.3.3 | 2.0 | CPE | Community Planning & Engagement Coordination | 5.0 | MVDE | Management of Volunteers during Emergencies | The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance | M346 | Number of total Medical Reserve Corps members per 100,000 population in the state | The Medical Reserve Corps (MRC) is a national system of local, community-based teams of volunteers—medical and public health professionals and others without health backgrounds—who are identified, credentialed, trained, and prepared in advance of an emergency. MRC-registered volunteers are vital to providing care to people with serious injuries or illnesses associated with mass casualty events and disease outbreaks. | MRC | Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel. | 2012—2014, 2016—2018 | The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals). |
| 45 | 45 | 74.0 | Index | 2.3.4 | 2.0 | CPE | Community Planning & Engagement Coordination | 5.0 | MVDE | Management of Volunteers during Emergencies | The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance | M176 | Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state | The Medical Reserve Corps (MRC) is a national system of local, community-based teams of volunteers—medical and public health professionals and others without health backgrounds—who are identified, credentialed, trained, and prepared in advance of an emergency. MRC-registered physicians are vital to providing care to people with serious injuries or illness associated with mass casualty events and disease outbreaks. | MRC | Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel. | 2015—2018 | The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training. |
| 46 | 46 | 78.0 | Index | 2.3.8 | 2.0 | CPE | Community Planning & Engagement Coordination | 5.0 | MVDE | Management of Volunteers during Emergencies | The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance | M179 | Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state | The Medical Reserve Corps (MRC) is a national system of local, community-based teams of volunteers—medical and public health professionals and others without health backgrounds—who are identified, credentialed, trained, and prepared in advance of an emergency. MRC-registered nurses are vital to providing emergency care for ill or injured people during a disaster or disease outbreak. | MRC | Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel. | 2015—2018 | The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training. |
| 47 | 47 | 85.0 | Index | 2.3.15 | 2.0 | CPE | Community Planning & Engagement Coordination | 5.0 | MVDE | Management of Volunteers during Emergencies | The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance | M186 | Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state | The Medical Reserve Corps (MRC) is a national system of local, community-based teams of volunteers—medical and public health professionals and others without health backgrounds—who are identified, credentialed, trained, and prepared in advance of an emergency. Other public health and medical professionals (e.g., epidemiologists, environmental engineers, toxicologists) can provide logistical support and information technology support as well as staff information hotlines and mass clinics, assist with registration, and perform health screening. | MRC | Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel. | 2015—2018 | The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training. |
| 48 | 48 | 93.0 | Index | 2.4.2 | 2.0 | CPE | Community Planning & Engagement Coordination | 5.5 | SCC | Social Capital & Cohesion | The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents. | M175 | Percent of voting-eligible population in the state participating in the highest office election | Voter participation is one proxy measure for social cohesion, which indicates the degree of connectedness and belonging that exists among members of a community. Cohesion is positively correlated with a community’s ability to recover from emergencies and disasters. Voter participation also is correlated with community involvement and trust in government. | USEP | United States Election Project, General Election Turnout Rates | 2012, 2014 & 2016 | The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election). |
| 49 | 49 | 94.0 | Index | 2.4.3 | 2.0 | CPE | Community Planning & Engagement Coordination | 5.5 | SCC | Social Capital & Cohesion | The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents. | M188 | Percent of adults in the state who volunteer in their communities | Community residents who volunteer, like those who vote, is an indicator of community cohesiveness. Rate of volunteerism is considered a representation of community involvement and engagement, which can strengthen pre-event planning as well as post-event response and recovery activities. | CPS Volunteer Supplement | Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel. | 2012—2015, 2017 | Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism. |
| 50 | 50 | 95.0 | Index | 2.4.4 | 2.0 | CPE | Community Planning & Engagement Coordination | 5.5 | SCC | Social Capital & Cohesion | The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents. | M189 | Number of annual volunteer hours per state resident, 15 years and older | Community residents who volunteer, like those who vote, have long been associated with more cohesive communities. This measure is another way of indirectly capturing the community-level benefits derived from those who "give back" or volunteer their time. | CPS Volunteer Supplement | Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel. | 2012—2015, 2017 | Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer. |
| 51 | 51 | 101.0 | Foundational | 3.1.1 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M10 | State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners | The measure focuses on a state public health laboratory's ability to effectively transmit information rapidly and electronically to partners and to coordinate response activities. | APHL AHLPS | Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey | 2013—2016 | The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state. |
| 52 | 52 | 104.0 | Index | 3.1.4 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M84 | State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP) | The measure focuses on the accreditation of a state according to a set of 64 standards for emergency management programs that covers program management, administration and finance, laws and authorities, hazard identification, risk assessment and consequence analysis, hazard mitigation, prevention, operational planning, incident management, resource management and logistics, mutual aid, communications and warning, operations and procedures, facilities, training, exercises, and crisis communications. Each area is important for managing an incident and assuring multi-agency coordination. | EMAP | Emergency Management Accreditation Program (EMAP), Who Is Accredited? | 2014—2018 | The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons. |
| 53 | 53 | 107.0 | Index | 3.1.7 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M107 | Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii | The measure estimates the capacity of the public health emergency management system by using emergency preparedness coordinators employed at local public health departments, or regional or district offices within the state, as the criteria. | NACCHO Profile | National Association of County and City Health Officials (NACCHO), 2013 National Profile of Local Health Departments | 2013 & 2016 | The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system. |
| 54 | 54 | 110.0 | Foundational | 3.1.10 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M229 | State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency | The measure focuses on the ability of a state to maintain a 24/7/365 contact system to receive notification of a public health emergency and activation of an incident management system that requires laboratory support. | APHL CLSS | Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS) | 2012 & 2014 | The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested. |
| 55 | 55 | 111.0 | Foundational | 3.1.11 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M150 | State uses a system for tracking hospital bed availability during emergencies | The ability for a state to track and update hospital bed availability continuously using a consistent, nationally-accepted platform is important for management of surge capacity during a mass casualty event. | ASPR HPP | Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program | 2012-2018 | The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation. |
| 56 | 56 | 115.1 | Index | 3.2.5 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M701 | Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty (reverse coded) | This performance indicator demonstrates the ability to immediately assemble public health staff with incident management lead roles to ensure a timely response to an incident. Specifically, this indicator captures an agency’s ability to assemble key decision-makers who are responsible for leading and managing a response. | CDC OPHPR | Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness | 2011—2016 | Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents. |
| 57 | 57 | 116.0 | Index | 3.1.16 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M344 | State has adopted the Nurse Licensure Compact (NLC) | The Nurse Licensure Compact allows licensed nurses residing in participating states the ability to practice in other participating states without applying for a new license. In the event of a significant disaster, Nurse Licensure Compact member states do not face licensing barriers when incorporating licensed nursing staff from other Nurse Licensure Compact member states into medical surge responses. States not party to this compact face increased administrative barriers when incorporating licensed nurses from other states into responses. | NCSBN NLC | National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States | 2014—2018 | The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact. |
| 58 | 58 | 128.0 | Foundational | 3.3.2 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M338 | State requires healthcare facilities to report healthcare-associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems | Healthcare-associated infections are a major, yet preventable, threat to patient safety. The National Health Safety Network (NHSN) is the CDC's system to collect surveillance data on these infections and to provide prevention strategies to healthcare facilities and providers. | CDC HAI | Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare—Associated Infections (HAI) Progress Report | 2012 & 2013 | The measure does not evaluate the healthcare facility compliance with reporting requirements. |
| 59 | 59 | 131.0 | Foundational | 3.3.5 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M341 | State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department | States with laws authorizing the release of PII without patient consent for purposes of responding to communicable diseases are able to more quickly implement effective response strategies to slow and stop the spread of disease. These laws include such information as to whom personally identifiable information may be released and the specific rationale or purpose for which such may be done. | PHLP | CDC Public Health Law Program resources. https://www.cdc.gov/phlp/ | 2013 | The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information. |
| 60 | 60 | 132.0 | Foundational | 3.3.6 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M342 | State law requires healthcare facilities to report communicable diseases to a health department | Prompt reporting of communicable diseases to the state or local health department is crucial to the control and prevention of disease outbreaks. State and local public health system disease surveillance and control activities are the backbone of the nation's ability to control the spread of communicable diseases. | NEDSS | Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS) | 2013 | The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information. |
| 61 | 61 | 135.0 | Foundational | 3.3.9 | 3.0 | IIM | Incident & Information Management | 7.0 | INCM | Incident Management | The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field. | M345 | State has adopted Emergency Management Assistance Compact (EMAC) legislation | The Emergency Management Assistance Compact (EMAC) establishes a legislative and legal foundation for interstate assistance in the event of a governor-declared emergency. This foundation settles issues of liability, responsibility, licensing, and credentialing prior to an emergency. This prior arrangement allows impacted states a more efficient means of identifying and securing assistance following an emergency. | NEMA EMAC | National Emergency Management Association (NEMA) | 2014 | The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses. |
| 62 | 62 | 120.0 | Foundational | 3.2.1 | 3.0 | IIM | Incident & Information Management | 8.0 | INFM | Information Management & Communications | The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available. | M64 | State has a public information and communication plan developed for a mass prophylaxis campaign | The measure reflects the capacity for timely public health risk communication during an emergency that requires dispensing of medical countermeasures. | CDC PHEP | Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program. | 2012-2018 | The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan. |
| 63 | 63 | 124.2 | Index | 3.2.5 | 3.0 | IIM | Incident & Information Management | 8.0 | INFM | Information Management | The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available. | M228 | Percent of households in the state with broadband in the home | The measure is focused on the availability of residential infrastructure that provides fixed internet connections. The measure assesses the households per state that maintain residential fixed connections. | U.S. Census Bureau | American Community Survey (ACS), 1-year estimate (GCT2801). | 2012—2017 | The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster. |
| 64 | 64 | 170.1 | Index | 4.2.21 | 3.0 | IIM | Incident & Information Management | 8.0 | INFM | Information Management | The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available. | M906 | Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region. | Adoption and use of EHRs may enhance continuity of clinical care operations when emergencies disrupt routine clinical transactions, and may enhance early detection of and response to hazards through electronic reporting and syndromic surveillance. | HHS ONCHIT | The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services | 2013—2016 | The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations. |
| 65 | 65 | 170.2 | Index | 4.2.22 | 3.0 | IIM | Incident & Information Management | 8.0 | INFM | Information Management | The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available. | M907 | Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region. | Adoption and use of EHRs may enhance continuity of clinical care operations when emergencies disrupt routine clinical transactions, and may enhance early detection of and response to hazards through electronic reporting and syndromic surveillance. | HHS ONCHIT | The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services | 2013—2016 | The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations. |
| 66 | 66 | 170.3 | Index | 4.2.23 | 3.0 | IIM | Incident & Information Management | 8.0 | INFM | Information Management | The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available. | M1001 | . The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure. | Digital 911 capabilities can transmit more information and process larger call volumes at faster speeds, with fewer risks of disruption, possibly enabling faster emergency response. | NG911 | National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT). | 2014—2017 | Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used. |
| 67 | 67 | 145.0 | Index | 4.1.7 | 4.0 | HD | Healthcare Delivery | 10.0 | PC | Prehospital Care | Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities. | M140 | Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state | Parametics and EMTs provide the workforce necessary to respond rapidly to individuals who experience acute health events, deliver initial care in the field, and provide transport to appropriate healthcare facilities for continued treatment. The size of this workforce is one indicator of a state’s surge capacity for large-scale emergencies and mass-casualty events. . | BLS OES | Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) | 2012—2017 | The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error. |
| 68 | 68 | 149.0 | Index | 4.1.11 | 4.0 | HD | Healthcare Delivery | 10.0 | PC | Prehospital Care | Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities. | M331 | Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state | The submission of EMS data to the national database allows state and federal officials to assess the timeliness and quality of EMS care. States can use the data to implement and evaluate improvements in EMS care, which may strengthen the ability to respond and recover from large-scale hazardous events. | NHTSA | National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information | 2015 & 2019 | The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements. |
| 69 | 69 | 149.1 | Index | 4.1.12 | 4.0 | HD | Healthcare Delivery | 10.0 | PC | Prehospital Care | Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities. | M349 | State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation | REPLICA may expand the availability of qualified EMS professionals during emergencies by providing a legal mechanism for licensed professionals to practice outside the state in which they are licensed. | NASEMSO | National Association of State EMS Officials | 2013—2018 | Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA. |
| 70 | 70 | 149.2 | Index | 4.1.13 | 4.0 | HD | Healthcare Delivery | 10.0 | PC | Prehospital Care | Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities. | M350U | The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas (reverse coded). | The response time of EMS may be indicative of first-responder capabilities and capacities during large-scale disasters. | NHTSA FARS | National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS) | 2015—2017 | Selected states fail to record response times for all fatal events. |
| 71 | 71 | 149.3 | Index | 4.1.14 | 4.0 | HD | Healthcare Delivery | 10.0 | PC | Prehospital Care | Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities. | M350R | The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas (reverse coded). | The response time of EMS may be indicative of first-responder capabilities and capacities during large-scale disasters. | NHTSA FARS | National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS) | 2015—2017 | Selected states fail to record response times for all fatal events. |
| 72 | 72 | 151.0 | Index | 4.2.1 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M147 | Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1)(reverse coded) | Measuring the time that patients spend admitted in the emergency department before being admitted to the hospital as an inpatient is important when managing medical surge (i.e., ramp up) and ensuring expeditious access to treatment during a public health emergency. | CMS TEC | Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care—State | 2013—2018 | The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge. |
| 73 | 73 | 152.0 | Index | 4.2.2 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M148 | Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2)(reverse coded) | Measuring the time that patients spend in the emergency department after the physician decides to admit a patient and before the patient is admitted into the facility as an inpatient is critical to understanding the challenges that may be experienced in terms of medical surge (i.e., ramp up). Understanding the patient movement flow and barriers can assist in surge planning for public health emergencies to increase patients' access to treatment and supportive care. | CMS TEC | Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care—State | 2013—2018 | The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event. |
| 74 | 74 | 155.0 | Index | 4.2.5 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M152 | Percent of the state’s population who live within 50 miles of a trauma center, including out-of-state centers | The measure indicates access to advanced trauma care at a Level I or II designation. In general, trauma centers are regional resources essential to assist in the management and rehabilitation of patients with injuries from various types of emergencies and disasters. A Level I Trauma Center is capable of providing the most complex care for severe injuries. A Level II Trauma Center can initiate definitive care for all injuries, but may need to transport complex cases to Level I facilities to complete treatment. | Estimated by PMO Staff | American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel. | 2012—2017 | The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers. |
| 75 | 75 | 157.0 | Index | 4.2.7 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M160 | Number of physicians and surgeons per 100,000 population in the state | Physicians and surgeons are important components of the workforce needed to diagnose and treat injuries and illnesses associated with mass casualty events and disease outbreaks. The size of the workforce is one indication of a state’s ability to surge (i.e., ramp up) the number of licensed professionals who provide rapid care during and after an emergency event. | ACS 1-Year Estimates | U.S. Census, American Community Survey | 2012—2017 | The measure does not consider mutual aid plans that may be in place for healthcare facilities to supplement the number of available physicians and surgeons in the event of an emergency. Also, BLS and other national data sources on physician supply have been shown to undercount certain types of physicians, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error. |
| 76 | 76 | 158.0 | Index | 4.2.8 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M167 | Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state | Registered nurses (RNs) and licensed practical nurses (LPNs) are an important part of the medical workforce that provides medical care in the acute and primary care settings. An increased number of these actively practicing and licensed healthcare workers would be needed to respond to a mass casualty or emerging disease epidemic/pandemic. The measure focuses on the state's workforce capacity of current, active registered and practical nurses (PNs). | NCSBN | National Council of State Boards of Nursing (NCSBN), National Nursing Database | 2013-2016, 2018 & 2019 | The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states. |
| 77 | 77 | 159.0 | Index | 4.2.9 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M168 | Percent of the state’s population living within 100 miles of a burn center, including out-of-state centers | Treatment of burns requires specialized resources and a highly trained multidisciplinary medical staff. This measure focuses on the capacity to provide a specialized medical infrastructure and medical staff capable of providing specialty burn care to trauma patients during a mass casualty incident. | ABA | American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel. | 2014 & 2018 | The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients. |
| 78 | 78 | 163.0 | Index | 4.2.13 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M296 | Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care) | Hospital-based geriatric care is an important inpatient service as the nation's population continues to age. Hospitals that provide geriatric care are better able to provide care and services to inpatient geriatric populations. | AHA | American Hospital Association (AHA), Annual Survey of Hospitals | 2012—2017 | The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program. |
| 79 | 79 | 164.0 | Index | 4.2.14 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M297 | Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program) | Effective provision of palliative care is an important consideration in providing care during a disaster or health security event. Hospitals that have established palliative care programs as part of their hospital facilities services are more likely to be able to provide these services during an emergency and are more likely to have these services integrated with the hospital emergency plan. | AHA | American Hospital Association (AHA), Annual Survey of Hospitals | 2012—2017 | The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency. |
| 80 | 80 | 165.0 | Index | 4.2.15 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M298 | Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states | Airborne infection isolation rooms (AIIRs) are important to the treatment and care of patients that have diseases that are spread through airborne transmission. The measure provides information on hospital resources that can be used for emergency preparedness activities, including planning and response. | AHA | American Hospital Association (AHA), Annual Survey of Hospitals | 2012—2017 | The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency. |
| 81 | 81 | 166.0 | Index | 4.2.16 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M299 | Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia | This measure is for risk-standardized all-cause 30-day mortality rates for Medicare patients aged 65 and older who are hospitalized with a principal diagnosis of heart attack, heart failure, or pneumonia. All-cause mortality is defined as death from any cause within 30 days after the index admission. This is a measure of the state's public health and healthcare system's programs, staffing, and requirements which influence recovery or mortality from an illness severe enough to require hospitalization. | CF Scorecard | The Commonwealth Fund, Aiming Higher: Results from a Scorecard on State health System Performance | 2011-2013, 2015 & 2016 | Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs. |
| 82 | 82 | 167.0 | Index | 4.2.17 | 4.0 | HD | Healthcare Delivery | 11.0 | HPS | Hospital and Physician Services | Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution. | M300 | Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score | The Hospital Safety Score uses 28 national performance measures from the Leapfrog Hospital Survey, the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS) to produce a single score representing the hospital's overall performance in keeping patients safe from preventable harm and medical errors. A grade "A" represents the best hospital safety score. Being able to provide patient safety and reduced medical errors during normal operations positions the hospital to perform better during health emergencies. | Leapfrog HSS | The Leapfrog Group, Hospital Safety Score (HSS) | 2013—2018 | The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region. |
| 83 | 83 | 178.0 | Index | 4.3.7 | 4.0 | HD | Healthcare Delivery | 12.0 | LTC | Long-Term Care | Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc. | M308 | Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state | Registered nurses (RNs) are important providers of skilled nursing care to residents. This measure is a reflection of core capacity for a clinical asset. | CMS NH | Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages | 2014—2018 | The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training. |
| 84 | 84 | 179.0 | Index | 4.3.8 | 4.0 | HD | Healthcare Delivery | 12.0 | LTC | Long-Term Care | Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc. | M309 | Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state | Certified nursing assistants (CNAs) provide important, non-nursing level care to residents and clients under their care. The average number of CNA staffing hours per resident per day is a reflection of core capacity and a measure of safety in terms of patient care. | CMS NH | Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages | 2014—2018 | The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training. |
| 85 | 85 | 180.0 | Index | 4.3.9 | 4.0 | HD | Healthcare Delivery | 12.0 | LTC | Long-Term Care | Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc. | M307 | Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine | This is a measure of the strength of the state's public health programs and general level of competency of long-stay resident facility managers as reflected in their effectiveness in risk avoidance through a seasonal vaccination program. It is also a measure of the population percentage who would have additional protection against seasonal flu, somewhat reducing the overall pressure on the healthcare system by mitigating the effect of seasonal flu during disaster response. | CMS NH | Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages | 2013—2018 | Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster. |
| 86 | 86 | 181.0 | Index | 4.3.10 | 4.0 | HD | Healthcare Delivery | 12.0 | LTC | Long-Term Care | Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc. | M310 | Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state | Licensed practical nurses (LPNs) are important members of the resident care team, and provide skilled nursing care. This measure is a reflection of core capacity for a clinical asset. | CMS NH | Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages | 2014—2018 | The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training. |
| 87 | 87 | 172.1 | Index | 4.3.15 | 4.0 | HD | Healthcare Delivery | 12.0 | LTC | Long-Term Care | Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc. | M303B | Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (1=Highest Quintile and 5=Lowest Quintile) | Nursing home residents are at increased risk for morbidity and mortality during emergencies. CMS requires facilities to maintain effective evacuation plans, emergency communication plans, and other protocols that can protect patients in emergency situations. | CMS | CMS Nursing Facility Inspection Reports | 2014—2018 | Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans. |
| 88 | 88 | 172.2 | Index | 4.3.16 | 4.0 | HD | Healthcare Delivery | 12.0 | LTC | Long-Term Care | Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc. | M23NH | Number of disease outbreaks in nursing homes or assisted living facilities per 1,000 certified nursing home residents in a state (reverse coded) | Nursing home residents are at increased risk of foodborne illnesses and face higher risks of serious complications and death. | CDC NORS | Centers for Disease Control and Prevention (CDC), National Outbreak Reporting System (NORS) | 2012—2017 | States vary in their ability to detect and report outbreaks in long-term care settings. |
| 89 | 89 | 190.0 | Index | 4.4.4 | 4.0 | HD | Healthcare Delivery | 13.0 | MBH | Mental & Behavioral Healthcare | Mental and behavioral healthcare is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population. | M316 | Percent of hospitals in the state providing psychiatric emergency services | This measure indicates psychiatric services that are owned or provided by a hospital or by a hospital's health system (i.e., don't require a contractual agreement). In times of disaster, psychiatric emergencies may occur and their prompt and efficacious treatment is important to a comprehensive behavioral health response. These emergency services may be treated in a number of settings, including hospitals. All hospitals are engaged in some level of disaster planning. If a hospital self-identifies as providing emergency psychiatric services, it is more likely that these services are coordinated/integrated with other disaster preparedness and response behavioral health efforts. | AHA | American Hospital Association (AHA), Annual Survey of Hospitals | 2012—2017 | The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services. |
| 90 | 90 | 191.0 | Index | 4.4.5 | 4.0 | HD | Healthcare Delivery | 13.0 | MBH | Mental & Behavioral Healthcare | Mental and behavioral healthcare is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population. | M317 | Percent of need met for mental health care in health professional shortage areas (HPSA) in the state | It is reasonable to assume that if an area has existing shortages in key behavioral health personal, preparedness for and response to a disaster may not be as robust as in areas where there are not staff shortages. It might also be assumed that if there are shortages in mental health professionals, there may also be shortages in other specialty care professions, again indicating that overall disaster health and mental/behavioral health preparedness and response may be limited. | HRSA HPSA | The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) | 2014, 2016—2018 | The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters. |
| 91 | 91 | 202.0 | Index | 4.4.16 | 4.0 | HD | Healthcare Delivery | 13.0 | MBH | Mental & Behavioral Healthcare | Mental and behavioral healthcare is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population. | M800 | Percent of the state’s population not living in an HRSA Mental Health Professional Shortage Area | Following an emergency event, individuals, families, and disaster responders may experience distress and anxiety about safety, health, and recovery and may require mental and behavioral health assistance, specifically calling on social workers' unique skills and training. The measure reflects a state's capacity to cope with its citizens' mental health needs. | U.S. Census & Health Resources & Services Administration (HRSA). | U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel. | 2015—2017, 2019 | The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas. |
| 92 | 92 | 204.0 | Index | 4.5.1 | 4.0 | HD | Healthcare Delivery | 14.0 | HC | Home Care | Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services. | M291 | Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season | Providing influenza vaccinations to vulnerable populations that are provided care through a home health agency is an indicator of the capability and quality of care provided by the agency. | CMS HH | Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data | 2013—2018 | Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster. |
| 93 | 93 | 205.0 | Index | 4.5.2 | 4.0 | HD | Healthcare Delivery | 14.0 | HC | Home Care | Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services. | M292 | Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner | The measure is an indicator of the capacity and effectiveness of the state's home care system to begin home care in a timely manner. Delays in providing home care can affect patient health and safety. The measure also indirectly looks at the hospital patient discharge system and its collaboration with home care providers. | CMS HH | Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data | 2013—2018 | The measure does not evaluate the quality of the services provided including length of service delays. |
| 94 | 94 | 206.0 | Index | 4.5.3 | 4.0 | HD | Healthcare Delivery | 14.0 | HC | Home Care | Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services. | M293 | Number of home health and personal care aides per 1,000 population in the state aged 65 or older | Home health and personal care aides provide important supportive care to those unable to live independently at home. These care providers are important to maintain the health and wellbeing of the clients under their care. During a health emergency, these providers may be crucial to implementing the emergency care plan for the home-based client. | ACS PUMS | American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average) | 2012—2017 | The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients. |
| 95 | 95 | 211.0 | Foundational | 5.1.1 | 5.0 | CM | Countermeasure Management | 15.0 | MMMDD | Medical Materiel Management, Distribution, & Dispensing | The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures. | M60 | State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements | State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements | The measure indicates whether a written plan exists to facilitate the receipt, distribution, and dispensing of protective supplies from the Strategic National Stockpile (SNS) quickly and efficiently. | CDC PHEP | 2012—2018 | The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner. |
| 96 | 96 | 220.0 | Index | 5.1.10 | 5.0 | CM | Countermeasure Management | 15.0 | MMMDD | Medical Materiel Management, Distribution, & Dispensing | The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures. | M161 | Number of Pharmacists per 100,000 population in the state | Pharmacists are highly educated, trained, and licensed healthcare professionals who dispense prescription medications to patients and offer advice on their safe use in a range of settings, including retail drugs stores, healthcare facilities, and academic research and training centers. They play a key and increasingly larger role in disaster-related countermeasure management and the dispensing of medicine. The measure focuses on state's workforce capacity of pharmacists. | BLS OES | Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) | 2012—2017 | The measure does not consider mutual aid plans that may be in place for healthcare facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error. |
| 97 | 97 | 221.0 | Index | 5.1.11 | 5.0 | CM | Countermeasure Management | 15.0 | MMMDD | Medical Materiel Management, Distribution, & Dispensing | The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures. | M270 | Percent of hospitals in the state participating in a group purchasing arrangement | Hospitals that participate in group purchasing can improve their effectiveness by attaining leverage with suppliers. This allows resources to concentrate on operational and clinical issues with a vision of improved patient outcomes. | AHA | American Hospital Association (AHA), Annual Survey of Hospitals | 2012—2017 | Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain. |
| 98 | 98 | 224.0 | Index | 5.2.1 | 5.0 | CM | Countermeasure Management | 16.0 | CUE | Countermeasure Utilization & Effectiveness | The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention. | M24 | Percent of children ages 19-35 months in the state receiving recommended routine childhood vaccinations, including four or more doses of diphtheria, tetanus, and pertussis vaccine, three or more doses of poliovirus vaccine, one or more doses of any measles-containing vaccine, and three or more doses of Hepatitis B vaccine | The measure is used by the Centers for Disease Control and Prevention (CDC) and states to monitor health status and is an important measure of achievement of immunization program objectives. The measure is a pre-event indicator of the capacity of the state's public and private immunization infrastructure needed to respond to an emerging vaccine-controllable disease. | CDC NIS | Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS) | 2012—2017 | The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease. |
| 99 | 99 | 225.0 | Index | 5.2.2 | 5.0 | CM | Countermeasure Management | 16.0 | CUE | Countermeasure Utilization & Effectiveness | The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention. | M32 | Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination | The measure focuses on adults aged 65+ who have had an influenza vaccination within the past year. This measure is used by the Centers for Disease Control and Prevention (CDC) and states to monitor health status and is an important measure of achievement of immunization program objectives. The measure is a pre-event indicator of the capacity of the state's public and private immunization infrastructure needed to respond to an emerging vaccine controllable disease. | CDC FluVaxView | Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report | 2013—2018 | Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster. |
| 100 | 100 | 226.0 | Index | 5.2.3 | 5.0 | CM | Countermeasure Management | 16.0 | CUE | Countermeasure Utilization & Effectiveness | The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention. | M33 | Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination | The measure focuses on adults aged 65+ who have ever had a pneumonia vaccination. The measure should be viewed alongside other measures in the Countermeasures Utilization Effectiveness sub-domain as an indicator of pre-event capacity of the state's immunization system. | CDC BRFSS | Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel. | 2012—2017 | The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease. |
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