Craig Thomas, chief of the Outcome Monitoring and Evaluation Branch in the Division of State and Local Readiness at the CDC provided an overview of metrics development at the CDC. The Division of State and Local Readiness administers the Public Health Emergency Preparedness (PHEP) Cooperative Agreement, which since 2001 has awarded over $8 billion to 62 state, territorial, and local grantees. At approximately $1 billion per year, this is one of the largest federal investments at the CDC, Thomas noted, and the CDC must develop metrics for assessing the degree to which the program is achieving its goals.
In a mass casualty response, the capabilities that the CDC sees as critical include incident management, crisis and emergency risk communication, countermeasures and mitigation (e.g., mass care, fatality management, responder safety and health), and surge management (e.g., medical surge, medical supply management, volunteer management).
Thomas highlighted several challenges to developing meaningful measures, especially for rural settings, starting with the fact that the integration of public health into EMS is relatively recent. In general, public health focuses more on continuous events (e.g., infectious disease outbreaks) than on discrete or acute emergency events (e.g., building collapse). In addition, measurement is hampered by the fact that roles and responsibilities are not always defined, especially for cross-jurisdictional incidents. And while not every service meets the necessary capabilities in the same way (nor is CDC prescribing a specific method to conduct a particular capability) some performance parameters need to be defined. An understaffed workforce is a pervasive issue in public health, more so recently with the economic downturn, and there is variation in core competencies for public health workers. Scarce resources have resulted in insufficient systems, equipment, and supplies. Maintaining and updating existing systems and equipment can be a challenge. Together, Thomas posited that these add up to a limited ability to operate in emergencies.
For its systematic approach to developing PHEP measures, the CDC first defines and describes the program, then applies evaluation tools and methods (e.g., process mapping, logic models) to generate activities that could be measured. As there is no solid evidence base, measures must be based on expert knowledge, experience, and published literature. The next