Washington Watch

Washington Watch

by Kathleen Ream, Director of Government Affairs

IOM Study Expanded
Due to additional funding from the Health Resources and Services Administration, the National Highway Traffic Safety Administration, and the Centers for Disease Control and Prevention, the scope of the current Institute of Medicine's (IOM) study on the "Future of Emergency Care in the U.S. Health System" is being expanded. The expansion includes more focused studies of both pediatric and pre-hospital EMS issues, as well as hospital-based emergency department issues, and will be conducted within an integrated overall study design. In addition, the expanded scope of the study has extended the project timeline - the Committee's reports are now expected to be released in late 2005, and early 2006. The revised statement of task is posted on the project website www.iom.edu/emergencycare.

The structure of the expanded project is as follows:

• The main IOM Committee will expand to approximately 25 members from the current 18. These additional members will provide representation from both pediatric and pre-hospital emergency care services.

• A 10 to 12 member Pre-hospital EMS Subcommittee is being established that will include up to seven members from the main Committee.

• A 10 to 12 member Pediatric Subcommittee will include up to seven members from the main Committee.

• A new 10 member Hospital-based Emergency Department Subcommittee will include up to eight members from the main Committee.

The Committee and each Subcommittee will produce separate reports dealing with their areas of focus. The main Committee will focus on the broad system issues, such as the safety net, federal funding, IT interoperability, and national EMS system coordination and planning, as well as linkages between the Subcommittees' areas of focus.

JCAHO Modifies Standard on ED Overcrowding
Last May, JCAHO singled out ED overcrowding as a safety problem responsible for treatment delays and inadequate care, and in a push to adopt ED crowding as the third initiative in its campaign to influence public policy affecting quality of care - drafted a proposed standard addressing the issue. The proposal was met with immediate criticism pointing out that many sources of ED overcrowding were outside the direct control of hospitals.

After reviewing the comments, JCAHO modified its proposal. Its new accreditation standard directs hospital leaders to identify and mitigate barriers to efficient patient flow throughout their facilities. The final revision emphasizes the role of leadership in motivating people throughout the hospital to expedite the movement of patients in general. In an article accompanying publication of the approved standard, Robert Wise, JCAHO's Vice President of Standards, said, "While the emergency department is a vulnerable area when patient flow issues occur, the improvements needed lie in organization-wide changes rather than changes solely in the emergency department."

GAO Finds Preparedness Programs Incomplete
A report released by the General Accounting Office (GAO) confirms that no state is fully prepared to respond to a major public health threat. GAO found that, while many states have improved their response capacity having invested in laboratory and communication capabilities, surveillance systems, and workforce development; gaps remain in surge capacity and in regional coordination and planning.

The anthrax incidents in the fall of 2001, the SARS outbreak in 2002 - 2003, and this year's influenza season have all raised concerns about the Nation's ability to respond to a major public health threat and to handle a pandemic. Because of these concerns, GAO was asked to examine improvements in state and local public health preparedness.

The GAO study assessed states' progress in complying with the agreements they reached with the federal government in 2002 to secure public health readiness funding. That funding, $1.1 billion, provided by the Department of Health and Human Services (HHS), was awarded to states through two cooperative agreement programs, the Centers for Disease Control and Prevention's (CDC) Public Health Preparedness and Response for Bioterrorism Program, and the Health Resources and Services Administration's (HRSA) National Bioterrorism Hospital Preparedness Program. (In September 2003, HHS made an additional $1.4 billion in grants available - again under cooperative agreements - to help states and public health systems prepare for bioterror attacks and other public health emergencies.) The 2002 cooperative agreement programs, which required participants to complete specific activities designed to build public health capacities, ended on August 30, 2003.

In their statements to GAO, state officials described a number of challenges in meeting the requirements in the 2002 agreements. They cited budget deficits, insufficient HRSA funding, the redirection of resources to the National Smallpox Vaccination Program, and delays caused by lengthy contracting processes for distributing funds from the state to the hospitals.

In regard to the 14 requirements CDC considers critical benchmarks of preparedness; GAO said that some were more likely to be completed than others. For example, most states have established a bioterrorism advisory committee. Likewise, most states have met the requirement that 90percent of their population be covered by the Health Alert Network, a nationwide program designed to ensure communication capacity at all state and local health departments. Few of the states, however, have met two benchmarks that GAO described as critical: development of a statewide response plan, and development of regional response plans. In addition, most states have not finalized plans for receiving and distributing medical supplies, vaccines, and other materials from the Strategic National Stockpile - a repository of pharmaceutical and medical supplies that can be delivered to the site of a biological or other attack.

As for HRSA's requirements, GAO said that no state has completed all of them. While almost all states reported having met two of the three critical benchmarks of hospital preparedness - designation of a coordinator for hospital preparedness planning, and establishment of a hospital preparedness planning committee, no state has met the third benchmark - development of a plan for the state's hospitals to respond to an epidemic involving at least 500 patients. In regard to the priority issues that HRSA required states to address, which include personal protection of health care workers, quarantine capacity, and communications, GAO said that states reported "varying degrees of progress."

In its study, GAO also found that, despite its recommendation in 2000, HHS has not yet published a federal influenza pandemic plan, and that most state plans have not been finalized. According to HHS, the federal plan is still under review, but most states are continuing to develop their own plans for responding to influenza.

GAO concluded that, although states' progress "fell short of 2002 program goals, CDC's and HRSA's cooperative programs have enabled states to make much needed improvements in the public health and health care capacities critical for preparedness. States are more prepared now than they were prior to these programs, but much remains to be accomplished." The report, HHS Bioterrorism Preparedness Programs: States Reported Progress but Fell Short of Program Goals for 2002, GAO-04-360R, s available at www.gao.gov.

Grants.Gov: New Federal Web Site
HHS Secretary Tommy Thompson recently unveiled a single, comprehensive Web site that contains information about finding and applying for all federal grant programs. To date, the site has information about more than 800 available grant programs involving all 26 federal grant-making agencies. The site also includes a "Find Grant Opportunities" feature to help applicants find potential funding opportunities, and contains an "Apply for Grants" feature that allows applicants to download, complete, and submit applications. For more grants information, go to www.grants.gov.

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