AHRQ's bioterrorism research portfolio: real linkages in real time - AHRQ Update

Health Services Research, Feb, 2004 by Sally Phillips, Helen Burstin, Carole D. Dillard, Carolyn M. Clancy

Responding to a bioterrorist event calls for critical communication and linkages in real time; among systems of care, the public health infrastructure and individual clinicians, law enforcement agents and emergency responders. In particular, there are many unanswered questions about the health care system's capacity to rapidly respond. How can an overburdened health care system ramp up to handle mass casualties? How will triage decisions be made rapidly and accurately? How can regional resources be used to provide surge capacity in the event of a bioterrorist attack? What are the early warning signs of such an event? To enhance health care system preparedness for bioterrorism, we need health services researchers to rise to the challenge and begin to develop and analyze the best evidence-based models, tools, and knowledge to address these potentially devastating threats.

THE RESEARCH CHALLENGE

How can we prepare to make evidence-based decisions when the events upon which these decisions might be based are rare occurrences?

The relative rarity of a public health emergency--whether it's the anthrax attacks of October 2001 or the occurrence of a "new" disease such as SARS--poses particular challenges to building an evidence base for future decision making. The potential volatility of such an event was dramatically illustrated when an AHRQ-funded staffing model for mass prophylaxis scheduled for testing on September 12, 2001 in New York City became an unscheduled live drill three weeks later in response to the anthrax attacks. While the research team at Weill Medical College of Cornell University did not anticipate an actual live application of their model, they were immediately called upon to move from the theoretical to the applied. When it comes to emergency preparedness, we must conceptualize the approach to research in an entirely different manner.

AHRQ: FORGING LINKAGES

Today, the Agency is working together with the Office of Public Health Emergency Preparedness within the Department of Health and Human Services, as well as sister agencies--including the Centers for Disease Control and Prevention and the Health Resources and Services Administration--on a number of bioterrorism response and preparedness initiatives at the federal, state, and local levels. In keeping with its longstanding track record of forging partnerships, the Agency has a particular mandate: to enhance and reinforce linkages between the personal health care delivery system and the public health infrastructure. The ability of the health care system to "surge" to meet overwhelming need has been a unique focus of AHRQ's research portfolio. Additionally, the Agency is assessing the training and information needs of community clinicians to diagnose and manage patients appropriately; assessing the preparedness of hospitals and health care systems; and analyzing the impact on cost, quality, and outcomes.

In forging these linkages, AHRQ is building research-based tools and models, emphasizing the utilization of information technology, and developing the research capacity needed to quickly and creatively test new approaches.

BUILDING THE EVIDENCE BASE

Even before the first anthrax attacks of 2001, the Agency was sponsoring research related to public health preparedness. In FY 2000, as part of the Department of Health and Human Services' larger bioterrorism research initiative, the Agency received $5 million for research aimed at improving the health care system's ability to respond to a bioterrorist event. Today, AHRQ's investment in bioterrorism-related research has nearly quadrupled to $24 million, with projects spanning eight key areas: (1) models for effective and efficient medication and vaccine distribution, (2) understanding the role of state and regional models for preparedness, (3) defining, measuring, and demonstrating surge capacity within the health care system, (4) the unique issues related to pediatric care and bioterrorism, (5) the role of health information technology to in detecting, tracking, and providing real-time decision support to clinicians, (6) methods and best practices for clinician training, (7) further development of health care system/public health care system linkages, and (8) translating research into practice. Additionally, the Agency's work complements the Department's investments in states (through the Centers for Disease Control and Prevention), and in hospitals (through the Health Resources and Services Administration), thereby ensuring that opportunities are maximized for health care providers to be part of the solution. For a list of AHRQ-funded projects and institutions working in these areas, see the Agency web site at http://www.ahrq.gov/research/bioterport.htm.

New technologies help address many of the "real time" needs of a prospective bioterrorism event, from detecting patterns before they become health threats to alerting providers before patients show up in their emergency departments. AHRQ's early investment in bioterrorism preparedness research is already yielding an impressive mix of web-based tools, software, decision support such as inventories that help locate critical resources, simulation models to support planning, surveys and questionnaires for hospital readiness, databases designed to detect trends and flag possible alerts, emergency alerts to physicians, and data analysis systems such as syndromic surveillance systems that look for patterns that would indicate a public health event.