The Six Degrees in Public Health Emergency Preparedness

The Six Degrees in Public Health Emergency Preparedness: Understanding How Local Agencies Collaborate in Rural Communities Margaret C. Wang, Ph.D., M.P.H. UCLA/RAND AcademyHealth Annual Research Meeting June 4, 2007 Bioterrorism Preparedness in Rural and Urban Communities   Funded by Agency for Healthcare Research and Quality (AHRQ) Principal Investigator – Aram Dobalian, J.D., Ph.D.  Co-Principal Investigator – R. Paul Duncan, Ph.D. – Jennie C.I. Tsao, Ph.D.  Research Team – – – – – Robert Brooks, M.D. Art Clawson, M.S. Silvia M. Menendez, J.D., M.S. Heather R. Rodriguez, Ph.D. Margaret C. Wang, Ph.D., M.P.H. AcademyHealth ARM 2 6/4/07 Background  Most efforts to improve public health emergency preparedness have focused on – Large, urban communities – Meeting immediate health needs following mass trauma  Public health infrastructure for responding to longer-term health effects in rural communities remains largely unexamined and unknown AcademyHealth ARM 3 6/4/07 Study Objectives  To determine among health care and social service organizations in rural and small urban communities – Information exchange infrastructure – Service referral patterns 6/4/07 AcademyHealth ARM 4 Rural Communities and Health    Approximately 80% of U.S. land is classified as rural 65 million Americans live in rural communities Rural communities may be especially burdened by longer-term natural and human-caused disasters AcademyHealth ARM 5 6/4/07 Theoretical Framework: Social Network Theory  Theoretical tenets – Relationships are important – Networks are conduits of information  Illustrative applications in health services research – Biotechnology industry – Inter-organizational collaboration for mental health services – Community partnership for chronic health care – Participants of collaborative care and quality improvement AcademyHealth ARM 6/4/07 6 Study Design  Network relational data among health and social service agencies – Frequency of communication – Referral relationships  Network analytic approach – Construct sociogram 6/4/07 AcademyHealth ARM 7 Study Populations  Study setting – Rural counties adjoining an urban center in Florida  10 responding organizations in the network – – – – – 4 Florida Department of Health outpatient clinics 1 federally qualified health center 3 private outpatient clinics 1 behavioral health specialty clinic 1 social service agency  Respondents – Individual (i.e., administrator/provider) in the organization who is familiar with coordination and service delivery of the organization 6/4/07 AcademyHealth ARM 8 Information Exchange Network Did the organization communicate with these other organizations? Rural OP Clinic Rural DOH Urban DOH Rural DOH BH Spec. Clinic Urban FQHC Rural OP Clinic Social Service Agency 6/4/07 AcademyHealth ARM Urban OP Clinic Rural DOH 9 Behavioral Health Service Referral Did the organization refer patients/clients to these other organizations? Social Service Agency Rural OP Clinic Rural DOH Rural OP Clinic BH Spec. Clinic Urban FQHC Urban DOH Urban OP Clinic Rural DOH Rural DOH 6/4/07 AcademyHealth ARM 10 Limitations & Next Steps  Wider network – Other health care organizations in the community (~40 more)    Hospitals/nursing homes Social service agencies Misc. assistance organizations  Valued network attributes – Frequency of communication – Intensity of referral relationships  Network characteristics – Network density – Point connectivity 6/4/07 AcademyHealth ARM 11 Summary and Conclusions    Central role of an urban health dept. underscores the important functions nearby urban facilities provide to rural residents On the flipside, the urban health dept. can draw on the resources of each of the rural organizations to address the need for post-disaster surge capacity Relative lack of connections among private agencies reflects concerns that private clinics might consider one another as potential competitors; while county health facilities may view one another as collaborators AcademyHealth ARM 12 6/4/07 Implications for Policy, Delivery, or Practice   Social network analysis is a useful analytic tool to examine the underlying information exchange network and service referral patterns among local health and social service agencies in rural and small urban communities Efforts should be made to promote collaboration among local health and social service agencies to improve emergency preparedness – Communication ties – Service referral network AcademyHealth ARM 13 6/4/07 For More Information on the Project  Aram Dobalian, Ph.D., J.D. – Research Health Scientist VA Greater Los Angeles Healthcare System – Assistant Professor UCLA Department of Health Services Phone: 310-267-5300  Email: adobalia@ucla.edu  6/4/07 AcademyHealth ARM 14 Medical Care Service Referral Did the organization refer patients/clients to these other organizations? Social Service Agency Rural OP Clinic Rural DOH Rural DOH Urban DOH BH Spec. Clinic Rural DOH Urban OP Clinic Urban FQHC 6/4/07 AcademyHealth ARM Rural OP Clinic 15 Medical Care Service Referral Did the organization receive patient/client referrals from these other organizations? Rural OP Clinic Social Service Agency Rural OP Clinic Urban OP Clinic Rural DOH Urban DOH BH Spec. Clinic Rural DOH Urban FQHC 6/4/07 AcademyHealth ARM Rural DOH 16 Behavioral Health Service Referral Did the organization receive patient/client referrals from these other organizations? Rural DOH Social Service Agency Rural DOH Rural OP Clinic Rural OP Clinic BH Spec. Clinic Urban DOH Rural DOH Urban OP Clinic 6/4/07 AcademyHealth ARM Urban FQHC 17