Extramural Research Program – Translation Research

Translation Research Project

PI Name: Peter D. Jacobson, JD, MPH
Project Period: 9/30/07-09/29/09
Project Title: Assessing the Impact of Federal and State Law on Public Health Preparedness
Website: http://www.sph.umich.edu/cleh/researchprojects.html#publichealthpreparedness

The purpose of this project is to assess and evaluate how the law shapes the public health system’s preparedness activities and its response to public health threats, such as infectious disease outbreaks, pandemic flu, and all hazards (including bioterrorism preparedness). The specific objectives are to examine: 1) the link between law and public health preparedness activities; 2) the extent and scope of legal mandates on state and local public health systems and whether those mandates facilitate or impede public health preparedness efforts; 3) how variations in state laws affect the use of federal and state funding streams to meet public health preparedness objectives; 4) how public health practitioners interpret and respond to federal and state laws affecting public health preparedness; and 5) to translate the findings into concrete policy recommendations for public health officials and legislators to implement. To meet these objectives, the investigators will first examine federal laws regarding public health preparedness, such as bioterrorism and infectious disease threats (including an examination of funding streams and performance measures). Then we will conduct a series of case studies of state and local public health systems to determine how state and federal law affects the public health system’s ability to respond more effectively to public health threats and other public health preparedness needs. The project’s primary contribution will be to provide policymakers with the first systematic empirical information to understand how law shapes the public health system’s disease preparedness activities, and how public health officials are adjusting to the changing legal environment. Another project goal is to bridge the gap between academic research and the issues public health practitioners face. Translating the research findings to the practitioner community is an important element of our overall strategy, an aspect of the research that we view as both crucial to the project’s success and an important contribution of this effort. Thus, we plan to recommend concrete strategies states and local health departments can use to address the implications of federal and state law and funding on their public health preparedness activities.

PI Name: James J. James, MD, DrPH, MHA
Project Period: 9/30/09-09/29/12
Project Title: A Health Security Card for Disasters and Public Health Emergencies
Website: http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response/health-security-card.shtml

The American Medical Association (AMA) seeks to promote the health, safety, and resilience of internally displaced populations in a disaster or public health emergency by establishing and promoting a standardized health security card, which contains essential data elements necessary for healthcare providers, and local, tribal, and state health departments to identify individuals, meet their immediate health needs, better access critical data, and better obtain surveillance and situational awareness, thereby minimizing morbidity and mortality in at- risk populations. An overarching participatory management methodology will be utilized to reach this goal. Specific aims include: 1) To utilize a multidisciplinary private-public stakeholder team to achieve consensus on the essential data elements necessary for a health security card for use in disasters and public health emergencies. 2) To establish consensus on the technological vehicle and platform for the card. 3) To refine and validate the vehicle and platform for the card through a series of focus groups targeting at-risk populations. 4) To disseminate the health security card to a nationally representative sample (n=1000), with an oversampling of at-risk populations, through selected training centers of the National Disaster Life SupportTM (NDLSTM) Program and in conjunction with local, tribal, and state public health departments, representing all FEMA regions. 5) To conduct a 6-week and 6-month follow-up evaluation and reliability test of the health security card and public health systems platform against the In Case of Emergency Prescription History Service (ICERx.org), a national medication record and pharmaceutical database. Analysis will include frequency of logins by the 6-week and 6-month time intervals, as well as completeness and accuracy of medication information compared with the ICERx medication database. A follow-up 6-month telephone survey will be conducted of all participants to determine subjective usability and portability of the health security card. The AMA is very capable of achieving success by virtue of its experience in building systems-level relationships and programs, and through its ability to leverage these networks to assist affected populations in a disaster or public health emergency. Building on past efforts, a primary goal of this project is to move the dissemination and utilization of an enhanced personal health information card from the clinician-patient model to a caregiver- population model to enable the deployment of the card across state-lines, especially for those most vulnerable and at greatest risk in a disaster or public health emergency. It is believed that the health security card can have a dual function by raising awareness and health literacy of at-risk populations thereby impacting and benefiting day-to-day clinical care, reducing overall healthcare costs, and improving individual and community resilience.

PI Name: Hendrika Meischke, PhD, MPH
Project Period: 9/30/09-09/29/12
Project Title: Extending Emergency Response Skills to Limited English Proficiency Communities

The objective of this proposal is to extend emergency response skills to communities with limited English proficiency (LEP) by investigating strategies for effective dissemination of bystander orr (cardio- pulmonary resuscitation) skills to LEP communities. Bystander orr has been proven to reduce mortality from cardiac arrest. Unfortunately, individuals from different ethnic communities are less likely to receive bystander CPR, possibly due to insufficient dissemination of orr training to these populations. A recent survey showed that Latino and Asian participants were less likely to report orr training than other ethnic groups in one large metropolitan community. In addition, research shows that orr instructions provided by 9-1-1 dispatch operators during a cardiac emergency are less likely to be accepted and performed by LEP callers compared to non-LEP callers. Where bystanders do perform CPR, the time-interval between onset of the emergency call and onset of bystander orr is more than a minute longer for LEP callers than non-LEP callers. Telephone- assisted orr has been shown to reduce mortality from cardiac arrest and as such the lack of understanding of orr instructions or significant delays in communication of instructions may negatively affect health outcomes. Proposed primary research activities include 1) focus group research with Asian and Latino LEP individuals to investigate awareness and acceptability of bystander orr and preferred channels for dissemination of basic orr skills training, 2) experimental research to test linguistically adapted 9-1-1 operator-assisted orr instructions on understanding and performance of orr among LEP and non-LEP individuals during a simulated cardiac arrest, and 3) observational research activities including 9-1-1 tape abstraction to evaluate the implementation of linguistically adapted dispatch-assisted orr instructions in two large call centers in the Pacific Northwest over a 9-month period. Secondary aims are to investigate the feasibility of video-based dissemination strategies for reaching Asian and Latino communities with basic orr training and dissemination of research results to other communities. All study activities are designed to involve community partners as well as representatives of LEP populations in Asian and Latino communities. Although orr is only one of many emergency preparedness and response techniques, both the evidence for benefit from bystander orr as well as the health disparities that exist in rates of bystander orr justify this focus. The results of the proposed research activities will lead to immediate changes at the system- level as new dispatch telephone instructions will become standard policy at the participating call centers after evaluation. In addition, the results will illuminate potential communication and dissemination strategies for reaching LEP communities with other types of emergency preparedness and response information.