Measuring Preparedness

Health
Security Surveillance

National
Confidence Interval
7.2 - 7.8
National
Preparedness Level
7.5

What it Means

Actions to monitor and detect health threats, and to identify where hazards start and spread so that they can be contained rapidly.

How we Measure it

Health Security Surveillance Sub-domains

phsei-health-surveillance-epidemiological-investigation

bmlt-biological-monitoring-laboratory-testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to:identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaksprovide relevant information to stakeholdersmonitor/investigate adverse events related to medical countermeasuresThe sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.

Measure
Measure Description
Source
m17
State participates in the Behavioral Risk Factor Surveillance System (BRFSS)
Measure Name

M17

Measure Source

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.

Data date(s)

2012 - 2014

Limitations

The BRFSS has significant challenges related to acquiring data on a local scale. Not all states participate in the BRFSS at the same level.

m18
{Number of} epidemiologists {per 100,000 population}
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012—2014

Limitations

This is not a measure of quality as epidemiologists can have varying levels of training and organizations may not always support sufficient continuing education. The measure does not include agency surge plans that can increase the number of epidemiologists available to respond to an event, nor mutual aid plans that can temporarily increase the number of epidemiologists.

m19
State participates in the Epidemic Information Exchange (Epi-X) System
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

Participation in the system is inferred from membership of staff and managers in a state, but it may not represent the actual level of attention the organization gives to alerts from the system.

m20
State participates in National Electronic Disease Surveillance System (NEDSS)
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013 - 2015

Limitations

The measure only considers a state's participation in the National Electronic Disease Surveillance System (NEDSS). The measure does not consider the quality of a state's disease surveillance system.

m22
State health department has an electronic syndromic surveillance system that can report and exchange information
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012

Limitations

Syndromic surveillance systems are an important tool for the early detection of potential disease outbreaks and other events. They rely on traditional disease surveillance and environmental monitoring systems to confirm events.

m217
Has your {state public health} laboratory implemented the Laboratory Information Management System (LIMS) capability to electronically receive and report laboratory information (e.g., electronic test order and report with hospitals and clinical labs, surveillance data from public health laboratory to epidemiology)?
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

Since the introduction of LIMS, newer technologies and standards have been introduced to laboratories, including policies requiring uptake of electronic laboratory reporting (ELR).

m220
Does your state have any legal requirement for nongovernmental (e.g., clinical, hospital-based) laboratories within your state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory?
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not collect data on what diseases are reportable. States also have requirements to submit the isolates of reportable diseases to public health laboratories.

m256
Does your state public health laboratory participate in the following federal surveillance programs [Foodborne Diseases Active Surveillance Network (FoodNet)]?
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

Participation is a "yes" or "no" determination, though from state to state the scope and quality of participation can vary significantly.

m23
{Proportion of} foodborne illness outbreaks reported to Centers for Disease Control and Prevention (CDC) for which an etiologic agent is confirmed
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC), Foodborne Online Outbreak Database (FOOD)

Data date(s)

2011 - 2013

Limitations

Certain states identify and report foodborne illness outbreaks more frequently than other states. This may increase the denominator and lower the state's percentage, creating a misleading view of the state's foodborne disease investigation program.

m289
State health department participates in a broad prevention collaborative addressing HAIs (healthcare-associated infections)
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure indicates that the state health department is a participant in the prevention collaborative, but the measure does not describe the state's rates of various types of healthcare-associated infections or if the rates are in decline as a result of the prevention collaborative. The measure does not indicate the percentage of state hospitals participating in the prevention collaborative.

m290
State has a public health veterinarian
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015

Limitations

A "yes" response indicates that this expert resource is present at the state level, but only implies that the state public health veterinarian is integrated into an animal response plan or is working in coordination with other animal-related resources such as a board of animal health or the state animal response team. The data source provides a list of contact information for each state's public health veterinarian, but no job description details or related material. Also, this source list is maintained for helping direct and develop uniform public health procedures involving zoonotic disease in the U.S. and its territories, so planning for animals in an emergency in the context of the Health Security Surveillance domain may only be a secondary consideration.

m265
{State} uses an Electronic Death Registration System (EDRS)
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014 & 2015

Limitations

The measure does not account for the quality of the death registration system, nor the timeliness with which deaths can be recorded. It also does not capture any redundant systems that might need to be used in place of the EDRS for certain scenarios such as cyber-attack and power outages.

m801
{In which} of the following federal surveillance programs does your {state public health} laboratory participate? [Influenza Centers for Disease Control and Prevention (CDC)/World Health Organization (WHO) Surveillance Network]
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

Participation is a "yes" or "no" determination, though from state to state the scope and quality of participation can vary significantly.

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.

Measure
Measure Description
Source
m1
Ability of Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories to collect, package, and ship samples properly during an LRN-C exercise
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011 - 2013

Limitations

In the exercise, all of the samples are simulated and real-life confounding issues like mislabeled specimens or specimens arriving at the laboratory at different times are not included. The current exercise is at best a demonstration of capability although it may not mimic real-life conditions.

m1314
Has your chemical terrorism/threat (CT) laboratory OR radiological terrorism/threat (RT) laboratory been certified or accredited by College of American Pathologists (CAP)? (1=Yes, 0=No)
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013 - 2015

Limitations

m208
Does your state public health laboratory have a USDA/APHIS (U.S. Department of Agriculture/Animal and Plant Health Inspection Service) permit for the importation and transportation of controlled materials, organisms, and vectors?
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure looks at a point in time. The permit must be renewed every year. Specific language is required on the permit; laboratories may not have entered all of the right information.

m8
Does your state public health laboratory have 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)?
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013 - 2015

Limitations

The measure specifically concerns how a laboratory must surge, or ramp up, their workforce in order to meet the testing demand of an infectious disease outbreak. Laboratories may have different ways of managing surge capacity.

m9
Does your {state public health} laboratory have a documented continuity of operations plan (COOP) consistent with National Incident Management System (NIMS) guidelines?
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013 - 2015

Limitations

The measure does not determine if the COOP is laboratory-specific or part of an agency plan. The measure does not evaluate the quality or comprehensiveness of the COOP.

m11
Does your {state public health} laboratory have a plan in place to receive samples from a sentinel clinical laboratory during nonbusiness hours?
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013 - 2015

Limitations

The measure may reflect that a laboratory has a plan in place, but does not reflect the frequency with which this plan may be used or tested. The ability to receive samples is only one step among many that result in rapid, accurate testing, which helps inform policy decisions in a response.

m12
Does your state public health laboratory currently have 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?
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013 - 2015

Limitations

The measure does not evaluate the time between pick-up and delivery. The measure does not look at the percentage of sentinel labs (i.e., hospital-based labs that have direct contact with patients) that are covered by the transport system.

m211
Does your {state public health} laboratory provide or assure the following laboratory tests? [arbovirus serology, hepatitis C serology, Legionella serology, measles serology, mumps serology, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, Varicella serology] If a state performs ALL of the 10 tests, it receives a "1" on this measure, otherwise a "0."
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

Laboratories will use a variety of methods to provide this testing, and it is not standard across all PHLs. Laboratories may have a difficult time answering the question, depending on how it is asked.

m216
Does your {state public health} laboratory provide or assure the following laboratory tests? [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] If a state performs ALL of the 15 tests, it receives a "1" on this measure, otherwise a "0."
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

Laboratories will use a variety of methods to provide this testing; it is not standard across all PHLs. Laboratories may have a difficult time answering the question, depending on how it is asked.

m2
Proportion of Laboratory Response Network biological (LRN-B) laboratory proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011 - 2013

Limitations

Proficiency tests are at best a test of a laboratory's capability. Proficiency tests are administered only a few times annually. Laboratories will lack proficiency tests for several years for many of the assays they are capable of performing.

m3
Percentage of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the PulseNet (PN) national database within four working days of receiving isolate at the PFGE laboratory
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011 - 2013

Limitations

The measure is limited to time to perform PFGE and upload data. The measure does not look at transport time or identification time. The measure is limited to foodborne agents that have PFGE subtyping.

m5
Proportion of agents correctly identified and quantified from unknown samples during unannounced proficiency testing {during the Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise}
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011 - 2013

Limitations

A proficiency test is at best a demonstration of capability. The current proficiency testing does not measure the public health laboratory's ability to process a large number of samples.

m7
Number of additional chemical agent detection methods demonstrated by Laboratory Response Network chemical (LRN-C) Level 1/Level 2 laboratories
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011 - 2013

Limitations

The measure is only looking at additional methods and not all methods the laboratory is capable of testing. Proficiency testing is the best demonstration of capability.

m286
{Total number of} chemical threat and multi-hazards preparedness exercises {or drills} your state public health laboratory conducted or participated in {annually}
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013 - 2015

Limitations

The measure includes all tabletop exercises, drills, functional exercises, and full-scale exercises for both chemical threats and multi-hazards (e.g., any combo of biological, chemical, and radiological threats).

m287
Percentage of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted to the PulseNet (PN) national database within four working days of receiving isolate at the PFGE laboratory
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011 - 2013

Limitations

The measure only evaluates the timeliness of identification and reporting of Listeria moncytogenies. The measure does not indicate how many samples are being processed per year, nor does it evaluate the quality of the PFGE results being submitted.

m288
Number of core methods (agents) demonstrated by Laboratory Response Network chemical (LRN-C) Level 1/Level 2 laboratories
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011 - 2013

Limitations

The measure focuses on standard laboratory procedures and fundamental tasks that are critical to the accurate identification of chemical agents. Standards set under the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program are critical components, as is success in achieving proficiency annually in the methods necessary to meet these capabilities.