Health Security Surveillance
9.4
8.4 National average
NATIONAL CONFIDENCE INTERVAL: 8.2 - 8.7
Drawing data from 64 sources, the 2021 Release includes seven years of data from 2013 to 2020. The Index is the most comprehensive look at states' preparedness to date. It is also the first national index that looks at the nation’s health security by collectively measuring the preparedness of the states. States face varying threats, apply preparedness principles in locally relevant ways, and have unique interdependencies. The display of results on the Index website takes into account both preparedness and model complexities.
The overall preparedness level in Virginia stands at 7.4 for 2020. The national average is 6.8.
NATIONAL CONFIDENCE INTERVAL: 8.2 - 8.7
NATIONAL CONFIDENCE INTERVAL: 5.1 - 5.7
NATIONAL CONFIDENCE INTERVAL: 8.7 - 9.1
NATIONAL CONFIDENCE INTERVAL: 4.8 - 5.2
NATIONAL CONFIDENCE INTERVAL: 5.9 - 6.6
NATIONAL CONFIDENCE INTERVAL: 6.6 - 7.2
The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.
M17
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 authors.
2012-2015
The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.
Foundational
M18
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction
2012-2019
The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
3.0
M19
Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program
2013
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M20
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013-2015
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M22
Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three
2012, 2016, & 2019
Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.
Yes
M217
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M220
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M256
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
M23
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
72.7%
M289
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports
2013
The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.
Foundational
M290
National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians
2014 & 2015, 2017-2020
The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.
Yes
M265
National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)
2014-2018, 2020-2021
The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.
No
M801
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
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, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.
M1
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2013
The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.
Foundational
M1314
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results
No
M208
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M8
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
No
M9
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M11
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
No
M12
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.
Yes
M211
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
90.0%
M216
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
80.0%
M2
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Laboratories may not undergo proficiency testing for all assay capabilities.
100.0%
M3
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.
94.0%
M5
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2013-2017
The measure does not consider the public health laboratory's ability to process a large number of samples.
50.0%
M7
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider all methods that the laboratory is capable of testing.
4.0
M286
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
4.0
M287
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.
92.0%
M288
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.
9.0
M911
Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M902
Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)
2016 & 2017
The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.
Yes
The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.
M87
Public Health Accreditation Board (PHAB), Health Departments in e-PHAB
2013-2020
The measure does not reflect health departments that are in process of achieving accreditation.
No
M501
National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.
2012, 2014, 2016 & 2018
Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.
11.6%
M9031
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
M9032
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
1.6%
M9033
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
5.0%
M9034
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
28.6%
Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.
M163
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.
80.3
M164
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.
25.3
M170
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.
96.6%
M53B
Youth Risk Behavior Survey
2011, 2013, 2015, 2017 & 2019
The measure is self-reported and does not distinguish reasons for safety concerns.
5.5%
The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.
M36
Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)
2014
The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.
Foundational
M266
Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.
2012-2014, 2016
The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.
66.1%
M346
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2012-2014, 2016-2018
The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).
14.2
M176
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.
6.0
M179
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.
46.5
M186
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.
106.2
The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.
M175
United States Election Project, General Election Turnout Rates
2012, 2014, 2016, 2018 & 2020
The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).
66.1%
M188
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.
28.5%
M189
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.
33.7
The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.
M10
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2016
The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.
Foundational
M84
Emergency Management Accreditation Program (EMAP), Who Is Accredited?
2014-2020
The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.
Yes
M107
National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments
2013 & 2016
The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.
100.0%
M229
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.
Foundational
M150
Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program
2012-2018
The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.
Foundational
M701
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.
26.0
M344
National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States
2014-2020
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.
Yes
M338
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report
2012 & 2013
The measure does not evaluate the health care facility compliance with reporting requirements.
Foundational
M341
CDC Public Health Law Program resources. https://www.cdc.gov/phlp/
2013
The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.
Foundational
M342
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013
The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.
Foundational
M345
National Emergency Management Association (NEMA)
2014
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.
Foundational
The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.
M64
Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.
2012-2018
The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.
Foundational
M228
American Community Survey (ACS), 1-year estimate (GCT2801).
2012-2019
The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.
72.5%
M906
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
89.0%
M907
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
40.0%
M1001
National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).
2014-2019
Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.
Yes
Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.
M140
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
52.6
M331
National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information
2015 & 2019
The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.
93.7%
M349
National Association of State EMS Officials
2013-2018, 2020-2021
Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.
No
M350U
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
7.9
M350R
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
12.6
Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.
M147
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2019
The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.
283.0
M148
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2020
The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.
97.0
M152
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.
99.6%
M160
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2011-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.
82.9
M167
National Council of State Boards of Nursing (NCSBN), National Nursing Database
2013-2016, 2018-2021
The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.
1,579.7
M168
American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.
2014 & 2018
The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.
98.0%
M296
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.
36.1%
M297
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.
32.0%
M298
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.
38.8
M299
The Commonwealth Fund, Scorecard on State Health System Performance
2011-2018
Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.
13.1%
M300
The Leapfrog Group, Hospital Safety Score (HSS)
2013-2020
The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
52.0%
Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.
M308
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
0.8
M309
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
2.4
M307
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2013-2021
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
92.5%
M310
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
1.1
M303B
CMS Nursing Facility Inspection Reports
2014-2020
Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.
4.0
M23NH
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
States vary in their ability to detect and report outbreaks in long-term care settings.
20.8
M880
Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies
2017-2020
Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.
49.2%
Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.
M316
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.
34.4%
M317
The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services
2014, 2016-2020
The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.
61.0%
M800
U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.
2015-2020
The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.
71.1%
Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.
M291
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
73.0%
M292
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
The measure does not evaluate the quality of the services provided including length of service delays.
91.0%
M293
American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)
2012-2019
The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.
30.0
The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.
M60
CDC PHEP
2012-2018
The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.
Foundational
M161
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
89.0
M270
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.
55.7%
The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.
M24
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)
2012-2019
The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.
69.8%
M32
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
69.7%
M33
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.
2012-2019
The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.
65.7%
M34
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2012-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
72.2%
M35
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
46.0%
The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.
M275_DW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
Yes
M275_PWW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_REC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_SUR
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M275_WST
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M276
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
100.0%
M195
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.
92.7%
M925
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.
81.0%
M23PC
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
25.4
The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.
M202
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M257_AIHA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
No
M257_EPA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M257_NELAC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M196
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Foundational
M272
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
90.0%
M273
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M274
National Plant Diagnostic Network (NPDN), National Plant Diagnostic website
2014
The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.
Foundational
M904
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041
2012-2019
The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
38.5
M23A
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.
0.1
Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.
M922
U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures
2012-2019
The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.
91.6%
M923
U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)
2016, 2018 & 2019
A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type. Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states
63.7%
M928
FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)
2017-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP.
48.5%
M929
U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)
2013-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP. Also, many flood zone maps are outdated.
53.5%
M334
Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation
2014-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.
Yes
Actions taken to protect workers and emergency responders from health hazards while on the job.
M530
Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.
2013-2020
Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.
58.3%
M531
Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.
2011-2013, 2015, 2017, 2019
The measure data is estimated based on a survey of a sample of the general population.
9.5%
M705
American Community Survey (ACS), 1-year estimate (Table B08128)
2012-2019
The measure data does not include all individuals who can work at home on a "part-time" basis.
4.7%
The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.
M17
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 authors.
2012-2015
The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.
Foundational
M18
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction
2012-2019
The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
1.0
M19
Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program
2013
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M20
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013-2015
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M22
Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three
2012, 2016, & 2019
Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.
Yes
M217
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M220
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M256
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
M23
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
64.3%
M289
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports
2013
The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.
Foundational
M290
National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians
2014 & 2015, 2017-2020
The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.
Yes
M265
National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)
2014-2018, 2020-2021
The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.
No
M801
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
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, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.
M1
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2013
The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.
Foundational
M1314
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results
No
M208
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M8
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
No
M9
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M11
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M12
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.
Yes
M211
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
100.0%
M216
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
93.3%
M2
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Laboratories may not undergo proficiency testing for all assay capabilities.
100.0%
M3
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.
100.0%
M5
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2013-2017
The measure does not consider the public health laboratory's ability to process a large number of samples.
100.0%
M7
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider all methods that the laboratory is capable of testing.
4.0
M286
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
4.0
M287
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.
100.0%
M288
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.
9.0
M911
Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M902
Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)
2016 & 2017
The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.
Yes
The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.
M87
Public Health Accreditation Board (PHAB), Health Departments in e-PHAB
2013-2020
The measure does not reflect health departments that are in process of achieving accreditation.
No
M501
National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.
2012, 2014, 2016 & 2018
Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.
36.0%
M9031
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
M9032
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
1.6%
M9033
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
7.9%
M9034
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
28.6%
Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.
M163
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.
80.2
M164
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.
25.1
M170
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.
96.6%
M53B
Youth Risk Behavior Survey
2011, 2013, 2015, 2017 & 2019
The measure is self-reported and does not distinguish reasons for safety concerns.
5.5%
The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.
M36
Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)
2014
The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.
Foundational
M266
Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.
2012-2014, 2016
The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.
66.2%
M346
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2012-2014, 2016-2018
The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).
157.9
M176
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.
5.5
M179
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.
46.1
M186
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.
106.3
The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.
M175
United States Election Project, General Election Turnout Rates
2012, 2014, 2016, 2018 & 2020
The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).
36.6%
M188
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.
30.4%
M189
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.
37.5
The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.
M10
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2016
The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.
Foundational
M84
Emergency Management Accreditation Program (EMAP), Who Is Accredited?
2014-2020
The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.
Yes
M107
National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments
2013 & 2016
The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.
100.0%
M229
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.
Foundational
M150
Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program
2012-2018
The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.
Foundational
M701
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.
28.0
M344
National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States
2014-2020
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.
Yes
M338
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report
2012 & 2013
The measure does not evaluate the health care facility compliance with reporting requirements.
Foundational
M341
CDC Public Health Law Program resources. https://www.cdc.gov/phlp/
2013
The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.
Foundational
M342
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013
The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.
Foundational
M345
National Emergency Management Association (NEMA)
2014
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.
Foundational
The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.
M64
Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.
2012-2018
The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.
Foundational
M228
American Community Survey (ACS), 1-year estimate (GCT2801).
2012-2019
The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.
75.8%
M906
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
91.0%
M907
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
52.0%
M1001
National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).
2014-2019
Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.
Yes
Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.
M140
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
56.0
M331
National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information
2015 & 2019
The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.
93.7%
M349
National Association of State EMS Officials
2013-2018, 2020-2021
Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.
No
M350U
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
7.9
M350R
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
12.6
Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.
M147
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2019
The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.
272.0
M148
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2020
The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.
93.0
M152
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.
99.6%
M160
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2011-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.
83.1
M167
National Council of State Boards of Nursing (NCSBN), National Nursing Database
2013-2016, 2018-2021
The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.
1,532.9
M168
American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.
2014 & 2018
The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.
98.0%
M296
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.
36.6%
M297
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.
31.7%
M298
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.
41.8
M299
The Commonwealth Fund, Scorecard on State Health System Performance
2011-2018
Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.
13.3%
M300
The Leapfrog Group, Hospital Safety Score (HSS)
2013-2020
The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
48.4%
Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.
M308
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
0.8
M309
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
2.4
M307
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2013-2021
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
90.9%
M310
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
1.1
M303B
CMS Nursing Facility Inspection Reports
2014-2020
Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.
4.0
M23NH
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
States vary in their ability to detect and report outbreaks in long-term care settings.
24.2
M880
Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies
2017-2020
Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.
49.2%
Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.
M316
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.
32.5%
M317
The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services
2014, 2016-2020
The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.
61.0%
M800
U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.
2015-2020
The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.
71.1%
Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.
M291
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
75.0%
M292
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
The measure does not evaluate the quality of the services provided including length of service delays.
92.0%
M293
American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)
2012-2019
The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.
31.6
The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.
M60
CDC PHEP
2012-2018
The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.
Foundational
M161
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
89.7
M270
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.
56.1%
The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.
M24
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)
2012-2019
The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.
69.2%
M32
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
69.1%
M33
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.
2012-2019
The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.
71.0%
M34
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2012-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
72.3%
M35
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
47.2%
The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.
M275_DW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
Yes
M275_PWW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_REC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_SUR
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M275_WST
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M276
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
100.0%
M195
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.
92.0%
M925
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.
86.5%
M23PC
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
23.7
The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.
M202
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M257_AIHA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
No
M257_EPA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M257_NELAC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M196
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Foundational
M272
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
90.0%
M273
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M274
National Plant Diagnostic Network (NPDN), National Plant Diagnostic website
2014
The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.
Foundational
M904
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041
2012-2019
The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
39.9
M23A
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.
0.1
Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.
M922
U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures
2012-2019
The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.
92.2%
M923
U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)
2016, 2018 & 2019
A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type. Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states
63.7%
M928
FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)
2017-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP.
48.5%
M929
U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)
2013-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP. Also, many flood zone maps are outdated.
51.9%
M334
Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation
2014-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.
Yes
Actions taken to protect workers and emergency responders from health hazards while on the job.
M530
Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.
2013-2020
Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.
58.6%
M531
Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.
2011-2013, 2015, 2017, 2019
The measure data is estimated based on a survey of a sample of the general population.
7.9%
M705
American Community Survey (ACS), 1-year estimate (Table B08128)
2012-2019
The measure data does not include all individuals who can work at home on a "part-time" basis.
4.5%
The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.
M17
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 authors.
2012-2015
The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.
Foundational
M18
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction
2012-2019
The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
1.0
M19
Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program
2013
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M20
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013-2015
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M22
Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three
2012, 2016, & 2019
Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.
Yes
M217
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M220
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M256
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
M23
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
54.6%
M289
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports
2013
The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.
Foundational
M290
National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians
2014 & 2015, 2017-2020
The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.
Yes
M265
National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)
2014-2018, 2020-2021
The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.
Yes
M801
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
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, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.
M1
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2013
The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.
Foundational
M1314
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results
No
M208
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M8
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
No
M9
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M11
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M12
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.
Yes
M211
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
100.0%
M216
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
93.3%
M2
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Laboratories may not undergo proficiency testing for all assay capabilities.
100.0%
M3
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.
98.0%
M5
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2013-2017
The measure does not consider the public health laboratory's ability to process a large number of samples.
100.0%
M7
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider all methods that the laboratory is capable of testing.
4.0
M286
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
4.0
M287
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.
100.0%
M288
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.
9.0
M911
Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M902
Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)
2016 & 2017
The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.
Yes
The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.
M87
Public Health Accreditation Board (PHAB), Health Departments in e-PHAB
2013-2020
The measure does not reflect health departments that are in process of achieving accreditation.
No
M501
National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.
2012, 2014, 2016 & 2018
Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.
36.0%
M9031
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
M9032
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
13.4%
M9033
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
10.1%
M9034
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
29.4%
Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.
M163
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.
83.8
M164
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.
25.0
M170
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.
96.4%
M53B
Youth Risk Behavior Survey
2011, 2013, 2015, 2017 & 2019
The measure is self-reported and does not distinguish reasons for safety concerns.
5.4%
The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.
M36
Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)
2014
The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.
Foundational
M266
Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.
2012-2014, 2016
The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.
66.1%
M346
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2012-2014, 2016-2018
The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).
157.9
M176
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.
5.5
M179
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.
46.1
M186
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.
106.3
The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.
M175
United States Election Project, General Election Turnout Rates
2012, 2014, 2016, 2018 & 2020
The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).
36.6%
M188
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.
31.4%
M189
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.
46.2
The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.
M10
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2016
The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.
Foundational
M84
Emergency Management Accreditation Program (EMAP), Who Is Accredited?
2014-2020
The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.
Yes
M107
National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments
2013 & 2016
The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.
100.0%
M229
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.
Foundational
M150
Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program
2012-2018
The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.
Foundational
M701
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.
25.0
M344
National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States
2014-2020
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.
Yes
M338
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report
2012 & 2013
The measure does not evaluate the health care facility compliance with reporting requirements.
Foundational
M341
CDC Public Health Law Program resources. https://www.cdc.gov/phlp/
2013
The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.
Foundational
M342
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013
The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.
Foundational
M345
National Emergency Management Association (NEMA)
2014
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.
Foundational
The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.
M64
Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.
2012-2018
The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.
Foundational
M228
American Community Survey (ACS), 1-year estimate (GCT2801).
2012-2019
The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.
77.2%
M906
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
92.0%
M907
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
58.0%
M1001
National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).
2014-2019
Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.
Yes
Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.
M140
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
61.1
M331
National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information
2015 & 2019
The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.
93.7%
M349
National Association of State EMS Officials
2013-2018, 2020-2021
Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.
Yes
M350U
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
7.9
M350R
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
12.6
Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.
M147
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2019
The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.
274.0
M148
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2020
The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.
92.0
M152
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.
99.2%
M160
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2011-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.
84.3
M167
National Council of State Boards of Nursing (NCSBN), National Nursing Database
2013-2016, 2018-2021
The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.
1,557.9
M168
American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.
2014 & 2018
The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.
98.0%
M296
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.
32.0%
M297
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.
34.4%
M298
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.
42.8
M299
The Commonwealth Fund, Scorecard on State Health System Performance
2011-2018
Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.
13.5%
M300
The Leapfrog Group, Hospital Safety Score (HSS)
2013-2020
The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
53.1%
Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.
M308
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
0.8
M309
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
2.3
M307
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2013-2021
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
89.4%
M310
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
1.1
M303B
CMS Nursing Facility Inspection Reports
2014-2020
Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.
4.0
M23NH
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
States vary in their ability to detect and report outbreaks in long-term care settings.
19.7
M880
Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies
2017-2020
Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.
49.2%
Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.
M316
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.
31.2%
M317
The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services
2014, 2016-2020
The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.
61.0%
M800
U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.
2015-2020
The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.
71.1%
Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.
M291
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
74.4%
M292
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
The measure does not evaluate the quality of the services provided including length of service delays.
92.0%
M293
American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)
2012-2019
The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.
34.3
The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.
M60
CDC PHEP
2012-2018
The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.
Foundational
M161
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
84.4
M270
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.
50.4%
The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.
M24
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)
2012-2019
The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.
73.7%
M32
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
67.7%
M33
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.
2012-2019
The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.
70.7%
M34
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2012-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
73.9%
M35
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
48.2%
The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.
M275_DW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
Yes
M275_PWW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_REC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_SUR
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M275_WST
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M276
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
100.0%
M195
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.
93.9%
M925
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.
84.9%
M23PC
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
49.8
The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.
M202
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M257_AIHA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
No
M257_EPA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M257_NELAC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M196
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Foundational
M272
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
90.0%
M273
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M274
National Plant Diagnostic Network (NPDN), National Plant Diagnostic website
2014
The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.
Foundational
M904
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041
2012-2019
The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
37.3
M23A
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.
0.0
Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.
M922
U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures
2012-2019
The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.
92.5%
M923
U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)
2016, 2018 & 2019
A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type. Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states
63.7%
M928
FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)
2017-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP.
48.5%
M929
U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)
2013-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP. Also, many flood zone maps are outdated.
49.6%
M334
Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation
2014-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.
Yes
Actions taken to protect workers and emergency responders from health hazards while on the job.
M530
Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.
2013-2020
Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.
58.8%
M531
Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.
2011-2013, 2015, 2017, 2019
The measure data is estimated based on a survey of a sample of the general population.
17.9%
M705
American Community Survey (ACS), 1-year estimate (Table B08128)
2012-2019
The measure data does not include all individuals who can work at home on a "part-time" basis.
4.4%
The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.
M17
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 authors.
2012-2015
The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.
Foundational
M18
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction
2012-2019
The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
1.0
M19
Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program
2013
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M20
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013-2015
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M22
Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three
2012, 2016, & 2019
Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.
Yes
M217
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M220
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M256
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
M23
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
60.0%
M289
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports
2013
The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.
Foundational
M290
National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians
2014 & 2015, 2017-2020
The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.
Yes
M265
National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)
2014-2018, 2020-2021
The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.
No
M801
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
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, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.
M1
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2013
The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.
Foundational
M1314
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results
Yes
M208
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M8
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M9
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M11
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M12
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.
Yes
M211
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
100.0%
M216
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
100.0%
M2
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Laboratories may not undergo proficiency testing for all assay capabilities.
100.0%
M3
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.
97.0%
M5
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2013-2017
The measure does not consider the public health laboratory's ability to process a large number of samples.
100.0%
M7
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider all methods that the laboratory is capable of testing.
4.0
M286
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
2.0
M287
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.
97.0%
M288
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.
9.0
M911
Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M902
Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)
2016 & 2017
The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.
Yes
The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.
M87
Public Health Accreditation Board (PHAB), Health Departments in e-PHAB
2013-2020
The measure does not reflect health departments that are in process of achieving accreditation.
No
M501
National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.
2012, 2014, 2016 & 2018
Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.
40.9%
M9031
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
M9032
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
15.1%
M9033
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
10.1%
M9034
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.
M163
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.
84.8
M164
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.
24.9
M170
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.
97.2%
M53B
Youth Risk Behavior Survey
2011, 2013, 2015, 2017 & 2019
The measure is self-reported and does not distinguish reasons for safety concerns.
6.1%
The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.
M36
Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)
2014
The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.
Foundational
M266
Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.
2012-2014, 2016
The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.
76.4%
M346
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2012-2014, 2016-2018
The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).
122.9
M176
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.
3.1
M179
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.
35.3
M186
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.
84.5
The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.
M175
United States Election Project, General Election Turnout Rates
2012, 2014, 2016, 2018 & 2020
The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).
66.1%
M188
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.
30.3%
M189
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.
38.2
The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.
M10
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2016
The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.
Foundational
M84
Emergency Management Accreditation Program (EMAP), Who Is Accredited?
2014-2020
The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.
Yes
M107
National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments
2013 & 2016
The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.
100.0%
M229
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.
Foundational
M150
Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program
2012-2018
The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.
Foundational
M701
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.
52.0
M344
National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States
2014-2020
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.
Yes
M338
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report
2012 & 2013
The measure does not evaluate the health care facility compliance with reporting requirements.
Foundational
M341
CDC Public Health Law Program resources. https://www.cdc.gov/phlp/
2013
The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.
Foundational
M342
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013
The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.
Foundational
M345
National Emergency Management Association (NEMA)
2014
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.
Foundational
The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.
M64
Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.
2012-2018
The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.
Foundational
M228
American Community Survey (ACS), 1-year estimate (GCT2801).
2012-2019
The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.
83.1%
M906
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
99.0%
M907
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
65.0%
M1001
National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).
2014-2019
Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.
Yes
Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.
M140
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
57.9
M331
National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information
2015 & 2019
The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.
93.7%
M349
National Association of State EMS Officials
2013-2018, 2020-2021
Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.
Yes
M350U
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
7.8
M350R
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
12.2
Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.
M147
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2019
The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.
272.0
M148
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2020
The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.
91.0
M152
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.
99.6%
M160
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2011-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.
85.6
M167
National Council of State Boards of Nursing (NCSBN), National Nursing Database
2013-2016, 2018-2021
The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.
1,554.1
M168
American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.
2014 & 2018
The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.
96.6%
M296
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.
41.9%
M297
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.
39.5%
M298
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.
45.0
M299
The Commonwealth Fund, Scorecard on State Health System Performance
2011-2018
Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.
13.5%
M300
The Leapfrog Group, Hospital Safety Score (HSS)
2013-2020
The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
44.4%
Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.
M308
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
0.8
M309
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
2.3
M307
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2013-2021
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
93.9%
M310
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
1.1
M303B
CMS Nursing Facility Inspection Reports
2014-2020
Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.
5.0
M23NH
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
States vary in their ability to detect and report outbreaks in long-term care settings.
21.6
M880
Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies
2017-2020
Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.
49.2%
Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.
M316
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.
33.9%
M317
The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services
2014, 2016-2020
The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.
57.4%
M800
U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.
2015-2020
The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.
71.1%
Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.
M291
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
76.3%
M292
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
The measure does not evaluate the quality of the services provided including length of service delays.
92.8%
M293
American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)
2012-2019
The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.
35.3
The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.
M60
CDC PHEP
2012-2018
The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.
Foundational
M161
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
85.6
M270
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.
55.6%
The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.
M24
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)
2012-2019
The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.
64.4%
M32
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
69.5%
M33
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.
2012-2019
The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.
74.3%
M34
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2012-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
74.7%
M35
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
46.0%
The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.
M275_DW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
Yes
M275_PWW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_REC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_SUR
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M275_WST
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M276
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
100.0%
M195
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.
92.5%
M925
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.
83.9%
M23PC
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
47.1
The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.
M202
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M257_AIHA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
No
M257_EPA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M257_NELAC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M196
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Foundational
M272
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
90.0%
M273
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M274
National Plant Diagnostic Network (NPDN), National Plant Diagnostic website
2014
The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.
Foundational
M904
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041
2012-2019
The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
33.5
M23A
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.
0.1
Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.
M922
U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures
2012-2019
The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.
92.8%
M923
U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)
2016, 2018 & 2019
A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type. Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states
63.7%
M928
FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)
2017-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP.
48.5%
M929
U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)
2013-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP. Also, many flood zone maps are outdated.
47.8%
M334
Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation
2014-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.
Yes
Actions taken to protect workers and emergency responders from health hazards while on the job.
M530
Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.
2013-2020
Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.
59.9%
M531
Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.
2011-2013, 2015, 2017, 2019
The measure data is estimated based on a survey of a sample of the general population.
24.0%
M705
American Community Survey (ACS), 1-year estimate (Table B08128)
2012-2019
The measure data does not include all individuals who can work at home on a "part-time" basis.
4.6%
The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.
M17
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 authors.
2012-2015
The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.
Foundational
M18
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction
2012-2019
The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
5.0
M19
Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program
2013
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M20
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013-2015
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M22
Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three
2012, 2016, & 2019
Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.
Yes
M217
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M220
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M256
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
M23
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
55.6%
M289
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports
2013
The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.
Foundational
M290
National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians
2014 & 2015, 2017-2020
The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.
Yes
M265
National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)
2014-2018, 2020-2021
The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.
Yes
M801
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
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, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.
M1
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2013
The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.
Foundational
M1314
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results
Yes
M208
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M8
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M9
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M11
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M12
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.
Yes
M211
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
100.0%
M216
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
100.0%
M2
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Laboratories may not undergo proficiency testing for all assay capabilities.
100.0%
M3
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.
100.0%
M5
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2013-2017
The measure does not consider the public health laboratory's ability to process a large number of samples.
100.0%
M7
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider all methods that the laboratory is capable of testing.
4.0
M286
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
7.0
M287
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.
100.0%
M288
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.
9.0
M911
Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M902
Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)
2016 & 2017
The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.
Yes
The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.
M87
Public Health Accreditation Board (PHAB), Health Departments in e-PHAB
2013-2020
The measure does not reflect health departments that are in process of achieving accreditation.
No
M501
National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.
2012, 2014, 2016 & 2018
Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.
40.9%
M9031
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
M9032
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
82.9%
M9033
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
67.7%
M9034
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.
M163
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.
84.7
M164
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.
24.7
M170
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.
97.1%
M53B
Youth Risk Behavior Survey
2011, 2013, 2015, 2017 & 2019
The measure is self-reported and does not distinguish reasons for safety concerns.
7.1%
The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.
M36
Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)
2014
The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.
Foundational
M266
Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.
2012-2014, 2016
The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.
76.4%
M346
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2012-2014, 2016-2018
The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).
119.4
M176
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.
3.2
M179
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.
34.3
M186
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.
81.9
The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.
M175
United States Election Project, General Election Turnout Rates
2012, 2014, 2016, 2018 & 2020
The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).
66.1%
M188
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.
34.0%
M189
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.
33.5
The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.
M10
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2016
The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.
Foundational
M84
Emergency Management Accreditation Program (EMAP), Who Is Accredited?
2014-2020
The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.
Yes
M107
National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments
2013 & 2016
The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.
100.0%
M229
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.
Foundational
M150
Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program
2012-2018
The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.
Foundational
M701
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.
9.0
M344
National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States
2014-2020
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.
Yes
M338
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report
2012 & 2013
The measure does not evaluate the health care facility compliance with reporting requirements.
Foundational
M341
CDC Public Health Law Program resources. https://www.cdc.gov/phlp/
2013
The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.
Foundational
M342
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013
The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.
Foundational
M345
National Emergency Management Association (NEMA)
2014
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.
Foundational
The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.
M64
Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.
2012-2018
The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.
Foundational
M228
American Community Survey (ACS), 1-year estimate (GCT2801).
2012-2019
The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.
83.4%
M906
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
99.0%
M907
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
65.0%
M1001
National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).
2014-2019
Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.
Yes
Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.
M140
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
60.7
M331
National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information
2015 & 2019
The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.
93.7%
M349
National Association of State EMS Officials
2013-2018, 2020-2021
Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.
Yes
M350U
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
10.5
M350R
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
12.4
Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.
M147
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2019
The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.
276.0
M148
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2020
The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.
91.0
M152
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.
99.5%
M160
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2011-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.
85.6
M167
National Council of State Boards of Nursing (NCSBN), National Nursing Database
2013-2016, 2018-2021
The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.
1,568.6
M168
American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.
2014 & 2018
The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.
96.6%
M296
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.
38.7%
M297
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.
39.5%
M298
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.
42.8
M299
The Commonwealth Fund, Scorecard on State Health System Performance
2011-2018
Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.
14.5%
M300
The Leapfrog Group, Hospital Safety Score (HSS)
2013-2020
The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
60.3%
Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.
M308
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
0.8
M309
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
2.3
M307
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2013-2021
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
94.8%
M310
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
1.1
M303B
CMS Nursing Facility Inspection Reports
2014-2020
Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.
5.0
M23NH
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
States vary in their ability to detect and report outbreaks in long-term care settings.
11.9
M880
Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies
2017-2020
Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.
49.2%
Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.
M316
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.
32.3%
M317
The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services
2014, 2016-2020
The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.
40.7%
M800
U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.
2015-2020
The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.
73.2%
Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.
M291
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
79.9%
M292
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
The measure does not evaluate the quality of the services provided including length of service delays.
93.7%
M293
American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)
2012-2019
The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.
35.0
The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.
M60
CDC PHEP
2012-2018
The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.
Foundational
M161
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
83.2
M270
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.
55.6%
The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.
M24
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)
2012-2019
The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.
65.9%
M32
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
67.1%
M33
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.
2012-2019
The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.
75.9%
M34
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2012-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
73.9%
M35
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
47.9%
The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.
M275_DW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
Yes
M275_PWW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_REC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_SUR
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M275_WST
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M276
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
100.0%
M195
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.
95.7%
M925
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.
84.4%
M23PC
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
13.8
The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.
M202
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M257_AIHA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
No
M257_EPA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M257_NELAC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M196
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Foundational
M272
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
90.0%
M273
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M274
National Plant Diagnostic Network (NPDN), National Plant Diagnostic website
2014
The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.
Foundational
M904
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041
2012-2019
The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
33.8
M23A
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.
0.0
Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.
M922
U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures
2012-2019
The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.
93.7%
M923
U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)
2016, 2018 & 2019
A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type. Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states
63.7%
M928
FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)
2017-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP.
48.5%
M929
U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)
2013-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP. Also, many flood zone maps are outdated.
49.2%
M334
Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation
2014-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.
Yes
Actions taken to protect workers and emergency responders from health hazards while on the job.
M530
Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.
2013-2020
Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.
60.3%
M531
Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.
2011-2013, 2015, 2017, 2019
The measure data is estimated based on a survey of a sample of the general population.
24.0%
M705
American Community Survey (ACS), 1-year estimate (Table B08128)
2012-2019
The measure data does not include all individuals who can work at home on a "part-time" basis.
5.0%
The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.
M17
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 authors.
2012-2015
The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.
Foundational
M18
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction
2012-2019
The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
2.0
M19
Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program
2013
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M20
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013-2015
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M22
Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three
2012, 2016, & 2019
Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.
Yes
M217
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M220
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M256
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
M23
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
75.0%
M289
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports
2013
The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.
Foundational
M290
National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians
2014 & 2015, 2017-2020
The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.
Yes
M265
National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)
2014-2018, 2020-2021
The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.
Yes
M801
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
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, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.
M1
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2013
The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.
Foundational
M1314
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results
Yes
M208
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M8
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M9
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M11
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M12
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.
Yes
M211
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
100.0%
M216
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
100.0%
M2
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Laboratories may not undergo proficiency testing for all assay capabilities.
100.0%
M3
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.
100.0%
M5
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2013-2017
The measure does not consider the public health laboratory's ability to process a large number of samples.
100.0%
M7
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider all methods that the laboratory is capable of testing.
4.0
M286
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
5.0
M287
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.
92.0%
M288
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.
9.0
M911
Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M902
Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)
2016 & 2017
The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.
Yes
The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.
M87
Public Health Accreditation Board (PHAB), Health Departments in e-PHAB
2013-2020
The measure does not reflect health departments that are in process of achieving accreditation.
No
M501
National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.
2012, 2014, 2016 & 2018
Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.
44.0%
M9031
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
M9032
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
82.9%
M9033
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
67.7%
M9034
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.
M163
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.
84.7
M164
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.
24.6
M170
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.
97.1%
M53B
Youth Risk Behavior Survey
2011, 2013, 2015, 2017 & 2019
The measure is self-reported and does not distinguish reasons for safety concerns.
7.1%
The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.
M36
Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)
2014
The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.
Foundational
M266
Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.
2012-2014, 2016
The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.
76.4%
M346
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2012-2014, 2016-2018
The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).
107.8
M176
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.
2.7
M179
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.
30.3
M186
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.
74.8
The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.
M175
United States Election Project, General Election Turnout Rates
2012, 2014, 2016, 2018 & 2020
The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).
66.1%
M188
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.
34.0%
M189
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.
33.5
The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.
M10
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2016
The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.
Foundational
M84
Emergency Management Accreditation Program (EMAP), Who Is Accredited?
2014-2020
The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.
Yes
M107
National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments
2013 & 2016
The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.
100.0%
M229
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.
Foundational
M150
Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program
2012-2018
The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.
Foundational
M701
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.
43.0
M344
National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States
2014-2020
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.
Yes
M338
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report
2012 & 2013
The measure does not evaluate the health care facility compliance with reporting requirements.
Foundational
M341
CDC Public Health Law Program resources. https://www.cdc.gov/phlp/
2013
The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.
Foundational
M342
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013
The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.
Foundational
M345
National Emergency Management Association (NEMA)
2014
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.
Foundational
The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.
M64
Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.
2012-2018
The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.
Foundational
M228
American Community Survey (ACS), 1-year estimate (GCT2801).
2012-2019
The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.
84.8%
M906
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
99.0%
M907
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
65.0%
M1001
National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).
2014-2019
Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.
Yes
Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.
M140
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
69.4
M331
National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information
2015 & 2019
The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.
32.0%
M349
National Association of State EMS Officials
2013-2018, 2020-2021
Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.
Yes
M350U
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
10.5
M350R
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
12.4
Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.
M147
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2019
The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.
275.0
M148
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2020
The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.
91.0
M152
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.
98.6%
M160
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2011-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.
85.7
M167
National Council of State Boards of Nursing (NCSBN), National Nursing Database
2013-2016, 2018-2021
The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.
1,585.1
M168
American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.
2014 & 2018
The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.
96.6%
M296
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.
43.6%
M297
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.
41.1%
M298
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.
40.1
M299
The Commonwealth Fund, Scorecard on State Health System Performance
2011-2018
Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.
14.1%
M300
The Leapfrog Group, Hospital Safety Score (HSS)
2013-2020
The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
60.3%
Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.
M308
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
0.6
M309
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
2.1
M307
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2013-2021
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
95.7%
M310
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
1.1
M303B
CMS Nursing Facility Inspection Reports
2014-2020
Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.
4.0
M23NH
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
States vary in their ability to detect and report outbreaks in long-term care settings.
10.1
M880
Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies
2017-2020
Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.
64.2%
Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.
M316
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.
42.7%
M317
The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services
2014, 2016-2020
The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.
39.9%
M800
U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.
2015-2020
The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.
72.2%
Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.
M291
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
81.9%
M292
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
The measure does not evaluate the quality of the services provided including length of service delays.
94.1%
M293
American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)
2012-2019
The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.
33.8
The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.
M60
CDC PHEP
2012-2018
The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.
Foundational
M161
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
82.4
M270
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.
50.8%
The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.
M24
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)
2012-2019
The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.
77.1%
M32
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
65.2%
M33
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.
2012-2019
The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.
77.1%
M34
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2012-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
83.1%
M35
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
43.4%
The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.
M275_DW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
Yes
M275_PWW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_REC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_SUR
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M275_WST
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M276
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
100.0%
M195
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.
95.7%
M925
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.
87.2%
M23PC
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
67.2
The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.
M202
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M257_AIHA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
No
M257_EPA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M257_NELAC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M196
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Foundational
M272
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
90.0%
M273
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M274
National Plant Diagnostic Network (NPDN), National Plant Diagnostic website
2014
The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.
Foundational
M904
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041
2012-2019
The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
33.2
M23A
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.
0.0
Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.
M922
U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures
2012-2019
The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.
94.5%
M923
U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)
2016, 2018 & 2019
A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type. Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states
42.1%
M928
FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)
2017-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP.
48.8%
M929
U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)
2013-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP. Also, many flood zone maps are outdated.
48.9%
M334
Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation
2014-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.
Yes
Actions taken to protect workers and emergency responders from health hazards while on the job.
M530
Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.
2013-2020
Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.
58.0%
M531
Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.
2011-2013, 2015, 2017, 2019
The measure data is estimated based on a survey of a sample of the general population.
22.5%
M705
American Community Survey (ACS), 1-year estimate (Table B08128)
2012-2019
The measure data does not include all individuals who can work at home on a "part-time" basis.
5.4%
The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.
M17
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 authors.
2012-2015
The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.
Foundational
M18
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction
2012-2019
The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
3.0
M19
Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program
2013
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M20
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013-2015
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M22
Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three
2012, 2016, & 2019
Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.
Yes
M217
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M220
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M256
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
M23
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
66.7%
M289
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports
2013
The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.
Foundational
M290
National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians
2014 & 2015, 2017-2020
The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.
Yes
M265
National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)
2014-2018, 2020-2021
The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.
Yes
M801
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
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, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.
M1
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2013
The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.
Foundational
M1314
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results
Yes
M208
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M8
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M9
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M11
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M12
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.
Yes
M211
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
100.0%
M216
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
100.0%
M2
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Laboratories may not undergo proficiency testing for all assay capabilities.
100.0%
M3
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.
98.0%
M5
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2013-2017
The measure does not consider the public health laboratory's ability to process a large number of samples.
100.0%
M7
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider all methods that the laboratory is capable of testing.
4.0
M286
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
11.0
M287
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.
100.0%
M288
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.
9.0
M911
Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M902
Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)
2016 & 2017
The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.
Yes
The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.
M87
Public Health Accreditation Board (PHAB), Health Departments in e-PHAB
2013-2020
The measure does not reflect health departments that are in process of achieving accreditation.
No
M501
National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.
2012, 2014, 2016 & 2018
Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.
44.0%
M9031
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
M9032
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
82.9%
M9033
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
67.7%
M9034
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.
M163
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.
88.5
M164
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.
23.8
M170
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.
97.0%
M53B
Youth Risk Behavior Survey
2011, 2013, 2015, 2017 & 2019
The measure is self-reported and does not distinguish reasons for safety concerns.
7.1%
The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.
M36
Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)
2014
The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.
Foundational
M266
Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.
2012-2014, 2016
The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.
76.4%
M346
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2012-2014, 2016-2018
The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).
107.8
M176
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.
2.7
M179
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.
30.3
M186
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.
74.8
The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.
M175
United States Election Project, General Election Turnout Rates
2012, 2014, 2016, 2018 & 2020
The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).
54.6%
M188
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.
34.0%
M189
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.
33.5
The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.
M10
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2016
The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.
Foundational
M84
Emergency Management Accreditation Program (EMAP), Who Is Accredited?
2014-2020
The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.
Yes
M107
National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments
2013 & 2016
The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.
100.0%
M229
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.
Foundational
M150
Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program
2012-2018
The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.
Foundational
M701
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.
44.0
M344
National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States
2014-2020
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.
Yes
M338
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report
2012 & 2013
The measure does not evaluate the health care facility compliance with reporting requirements.
Foundational
M341
CDC Public Health Law Program resources. https://www.cdc.gov/phlp/
2013
The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.
Foundational
M342
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013
The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.
Foundational
M345
National Emergency Management Association (NEMA)
2014
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.
Foundational
The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.
M64
Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.
2012-2018
The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.
Foundational
M228
American Community Survey (ACS), 1-year estimate (GCT2801).
2012-2019
The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.
85.6%
M906
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
99.0%
M907
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
65.0%
M1001
National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).
2014-2019
Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.
Yes
Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.
M140
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
72.5
M331
National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information
2015 & 2019
The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.
32.0%
M349
National Association of State EMS Officials
2013-2018, 2020-2021
Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.
Yes
M350U
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
Data Missing
M350R
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
Data Missing
Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.
M147
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2019
The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.
278.0
M148
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2020
The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.
93.0
M152
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.
99.8%
M160
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2011-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.
84.9
M167
National Council of State Boards of Nursing (NCSBN), National Nursing Database
2013-2016, 2018-2021
The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.
1,577.6
M168
American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.
2014 & 2018
The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.
96.6%
M296
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.
41.5%
M297
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.
41.5%
M298
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.
40.2
M299
The Commonwealth Fund, Scorecard on State Health System Performance
2011-2018
Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.
13.8%
M300
The Leapfrog Group, Hospital Safety Score (HSS)
2013-2020
The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
55.9%
Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.
M308
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
0.7
M309
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
2.1
M307
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2013-2021
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
96.0%
M310
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
1.1
M303B
CMS Nursing Facility Inspection Reports
2014-2020
Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.
4.0
M23NH
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
States vary in their ability to detect and report outbreaks in long-term care settings.
14.4
M880
Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies
2017-2020
Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.
64.2%
Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.
M316
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.
41.5%
M317
The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services
2014, 2016-2020
The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.
42.6%
M800
U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.
2015-2020
The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.
72.5%
Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.
M291
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
82.6%
M292
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
The measure does not evaluate the quality of the services provided including length of service delays.
95.3%
M293
American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)
2012-2019
The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.
31.1
The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.
M60
CDC PHEP
2012-2018
The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.
Foundational
M161
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
81.8
M270
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.
49.6%
The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.
M24
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)
2012-2019
The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.
78.4%
M32
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
71.4%
M33
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.
2012-2019
The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.
73.9%
M34
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2012-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
84.6%
M35
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
50.6%
The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.
M275_DW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
Yes
M275_PWW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_REC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_SUR
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M275_WST
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M276
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
100.0%
M195
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.
95.7%
M925
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.
87.1%
M23PC
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
20.9
The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.
M202
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M257_AIHA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
No
M257_EPA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M257_NELAC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M196
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Foundational
M272
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
90.0%
M273
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M274
National Plant Diagnostic Network (NPDN), National Plant Diagnostic website
2014
The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.
Foundational
M904
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041
2012-2019
The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
37.0
M23A
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.
0.0
Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.
M922
U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures
2012-2019
The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.
95.4%
M923
U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)
2016, 2018 & 2019
A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type. Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states
42.1%
M928
FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)
2017-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP.
48.8%
M929
U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)
2013-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP. Also, many flood zone maps are outdated.
48.9%
M334
Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation
2014-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.
Yes
Actions taken to protect workers and emergency responders from health hazards while on the job.
M530
Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.
2013-2020
Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.
57.8%
M531
Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.
2011-2013, 2015, 2017, 2019
The measure data is estimated based on a survey of a sample of the general population.
22.5%
M705
American Community Survey (ACS), 1-year estimate (Table B08128)
2012-2019
The measure data does not include all individuals who can work at home on a "part-time" basis.
5.6%
The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.
M17
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 authors.
2012-2015
The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.
Foundational
M18
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction
2012-2019
The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
3.0
M19
Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program
2013
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M20
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013-2015
The measure does not evaluate the quality or comprehensiveness of state participation in the system.
Foundational
M22
Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three
2012, 2016, & 2019
Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.
Yes
M217
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M220
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M256
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
M23
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
68.2%
M289
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports
2013
The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.
Foundational
M290
National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians
2014 & 2015, 2017-2020
The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.
Yes
M265
National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)
2014-2018, 2020-2021
The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.
Yes
M801
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
Foundational
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, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.
M1
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2013
The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.
Foundational
M1314
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results
Yes
M208
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M8
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M9
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M11
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
Yes
M12
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.
Yes
M211
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
100.0%
M216
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
100.0%
M2
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Laboratories may not undergo proficiency testing for all assay capabilities.
100.0%
M3
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.
98.0%
M5
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2013-2017
The measure does not consider the public health laboratory's ability to process a large number of samples.
100.0%
M7
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider all methods that the laboratory is capable of testing.
4.0
M286
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2020
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
6.0
M287
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.
100.0%
M288
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.
9.0
M911
Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M902
Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)
2016 & 2017
The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.
Yes
The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.
M87
Public Health Accreditation Board (PHAB), Health Departments in e-PHAB
2013-2020
The measure does not reflect health departments that are in process of achieving accreditation.
No
M501
National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.
2012, 2014, 2016 & 2018
Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.
44.0%
M9031
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
M9032
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
82.9%
M9033
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
67.7%
M9034
Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services
2013-2017
The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
100.0%
Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.
M163
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.
85.8
M164
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2010, 2015-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.
24.0
M170
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.
97.0%
M53B
Youth Risk Behavior Survey
2011, 2013, 2015, 2017 & 2019
The measure is self-reported and does not distinguish reasons for safety concerns.
8.6%
The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.
M36
Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)
2014
The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.
Foundational
M266
Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.
2012-2014, 2016
The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.
76.4%
M346
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2012-2014, 2016-2018
The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).
107.8
M176
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.
2.7
M179
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.
30.3
M186
Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.
2015-2018
The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.
74.8
The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.
M175
United States Election Project, General Election Turnout Rates
2012, 2014, 2016, 2018 & 2020
The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).
72.0%
M188
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.
34.0%
M189
Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.
2012-2015, 2017
Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.
33.5
The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.
M10
Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey
2013-2016
The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.
Foundational
M84
Emergency Management Accreditation Program (EMAP), Who Is Accredited?
2014-2020
The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.
Yes
M107
National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments
2013 & 2016
The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.
100.0%
M229
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.
Foundational
M150
Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program
2012-2018
The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.
Foundational
M701
Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness
2011-2017
Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.
44.0
M344
National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States
2014-2020
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.
Yes
M338
Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report
2012 & 2013
The measure does not evaluate the health care facility compliance with reporting requirements.
Foundational
M341
CDC Public Health Law Program resources. https://www.cdc.gov/phlp/
2013
The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.
Foundational
M342
Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)
2013
The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.
Foundational
M345
National Emergency Management Association (NEMA)
2014
The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.
Foundational
The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.
M64
Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.
2012-2018
The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.
Foundational
M228
American Community Survey (ACS), 1-year estimate (GCT2801).
2012-2019
The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.
86.7%
M906
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
99.0%
M907
The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services
2013-2016
The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
65.0%
M1001
National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).
2014-2019
Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.
Yes
Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.
M140
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
71.8
M331
National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information
2015 & 2019
The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.
32.0%
M349
National Association of State EMS Officials
2013-2018, 2020-2021
Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.
Yes
M350U
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
Data Missing
M350R
National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)
2015-2019
Selected states fail to record response times for all fatal events.
Data Missing
Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.
M147
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2019
The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.
278.0
M148
Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State
2013-2020
The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.
85.0
M152
American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.
2012-2018
The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.
99.8%
M160
U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)
2011-2018
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.
83.7
M167
National Council of State Boards of Nursing (NCSBN), National Nursing Database
2013-2016, 2018-2021
The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.
1,604.3
M168
American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.
2014 & 2018
The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.
96.6%
M296
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.
41.5%
M297
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.
41.5%
M298
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.
40.2
M299
The Commonwealth Fund, Scorecard on State Health System Performance
2011-2018
Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.
13.5%
M300
The Leapfrog Group, Hospital Safety Score (HSS)
2013-2020
The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
52.9%
Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.
M308
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
0.7
M309
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
2.1
M307
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2013-2021
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
96.0%
M310
Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages
2014-2021
The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
1.1
M303B
CMS Nursing Facility Inspection Reports
2014-2020
Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.
3.0
M23NH
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
States vary in their ability to detect and report outbreaks in long-term care settings.
12.3
M880
Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies
2017-2020
Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.
54.0%
Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.
M316
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.
41.5%
M317
The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services
2014, 2016-2020
The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.
46.4%
M800
U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.
2015-2020
The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.
72.5%
Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.
M291
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
81.8%
M292
Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data
2013-2020
The measure does not evaluate the quality of the services provided including length of service delays.
96.1%
M293
American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)
2012-2019
The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.
31.2
The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.
M60
CDC PHEP
2012-2018
The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.
Foundational
M161
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)
2012-2019
The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
88.0
M270
American Hospital Association (AHA), Annual Survey of Hospitals
2012-2018
Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.
49.6%
The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.
M24
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)
2012-2019
The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.
75.0%
M32
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
73.5%
M33
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.
2012-2019
The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.
75.6%
M34
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2012-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
81.9%
M35
Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report
2013-2020
Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.
55.7%
The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.
M275_DW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
Yes
M275_PWW
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_REC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Yes
M275_SUR
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M275_WST
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M276
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
100.0%
M195
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.
96.7%
M925
Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data
2012-2019
The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.
85.9%
M23PC
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
47.1
The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.
M202
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M257_AIHA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
No
M257_EPA
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M257_NELAC
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
Yes
M196
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012 & 2014
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
Foundational
M272
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
90.0%
M273
Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)
2012, 2014, 2016, and 2018
The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
Yes
M274
National Plant Diagnostic Network (NPDN), National Plant Diagnostic website
2014
The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.
Foundational
M904
Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041
2012-2019
The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
38.3
M23A
Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.
2012-2019
The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.
0.1
Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.
M922
U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures
2012-2019
The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.
95.6%
M923
U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)
2016, 2018 & 2019
A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type. Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states
42.1%
M928
FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)
2017-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP.
48.8%
M929
U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)
2013-2018
Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP. Also, many flood zone maps are outdated.
48.9%
M334
Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation
2014-2020
The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.
Yes
Actions taken to protect workers and emergency responders from health hazards while on the job.
M530
Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.
2013-2020
Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.
57.0%
M531
Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.
2011-2013, 2015, 2017, 2019
The measure data is estimated based on a survey of a sample of the general population.
27.9%
M705
American Community Survey (ACS), 1-year estimate (Table B08128)
2012-2019
The measure data does not include all individuals who can work at home on a "part-time" basis.
5.8%