Emergency Preparedness and Community Coalitions: Opportunities and Challenges

Study Examines Barriers to Broader Community Collaboration to Prepare for Disasters

News Release
Nov. 15, 2012

Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—While hospitals and first responders consistently work together to prepare for natural disasters, infectious disease outbreaks and other emergencies likely to result in many injured or ill people, other important groups—primary care clinicians and nursing homes, for example—typically do not participate in local emergency-preparedness coalitions, according to a new qualitative study of 10 U.S. communities by the Center for Studying Health System Change (HSC).

Emergency preparedness requires coordination of diverse entities at the local, regional and national levels. Community-based coalitions are intended to foster local preparedness and minimize the need for federal intervention, according to the study funded by the U.S. Centers for Disease Control and Prevention.

Given the diversity of stakeholders, fragmentation of local health care systems and limited resources, developing and sustaining broad community coalitions focused on emergency preparedness is difficult, the study found.

“Health care providers’ focus on emergency-preparedness activities waxes and wanes, reflecting the many pressures and competing demands they face. While maintaining normal operations, they must prepare for low-probability, high-impact events that can sharply increase demand for care and stress capacity to the breaking point,” said HSC Senior Researcher Emily Carrier, M.D., M.C.S.I., coauthor of the study with HSC Researcher Tracy Yee, Ph.D.; Dori Cross, HSC research assistant; and Divya Samuel, former HSC research assistant.

Using the lens of the 2009 H1N1 influenza pandemic, the study examined emergency-preparedness coalitions in 10 U.S. communities: Boston; Chicago; Greenville, S.C.; Indianapolis, Miami; New York City; Phoenix; Orange County, Calif.; Seattle; and Syracuse, N.Y.; and included rural communities adjacent to the Greenville, Phoenix and Seattle markets. Researchers conducted 67 telephone interviews between June 2011 and May 2012 with representatives of state and local emergency management agencies and health departments, emergency-preparedness coalitions, hospital emergency-preparedness departments, primary care practices and other organizations.

The study findings are detailed in a new HSC Research Brief—Emergency Preparedness and Community Coalitions:  Opportunities and Challenges—available online here. Key findings include:

The study identified two general approaches that policy makers could consider to broaden participation in emergency-preparedness coalitions: providing incentives for more stakeholders to join existing preparedness coalitions or building preparedness into activities providers already are pursuing.

One approach could be to provide funding aimed directly at supporting independent physicians’ and other underrepresented stakeholders’ participation. However, lack of funding—while an important problem—is not the only barrier to these groups’ involvement. Lack of time, training and sometimes simply awareness that they have a role in disaster response also are important factors.

Another option would be to incorporate preparedness activities into existing incentive programs aimed at underrepresented stakeholders. For example, programs that offer extra payment to primary care practices to coordinate care of patients with specific chronic conditions might also encourage and reward coordination related to emergency preparedness or the creation of business continuity plans. Likewise, hospital efforts to work with physician practices and long-term care facilities to prevent avoidable readmissions might incorporate joint preparedness activities.

### ###

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.