CD PRIORITIZATION PROJECT

SUMMARY REPORTNOVEMBER 1, 2012

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CALIFORNIA ASSOCIATION OF COMMUNICABLE DISEASE CONTROLLERS (CACDC)

OBJECTIVES

At the conclusion of this presentation participants will be able to:

• Describe how the CD Prioritization Matrix can provide a systematic approach to review and document prioritization of communicable disease follow-up at the local level

• Discuss strategies local jurisdictions have made to try and mitigate the negative impact of budget reductions on program activities

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BACKGROUND• The focus of the CD Prioritization Project was to

determine how Local Health Jurisdictions (LHJs) were prioritizing CD Control activities in light of diminishing resources

• Due to the variability of each LHJ the goal of developing a guidance document was modified to developing a CD Prioritization Matrix

• The project addressed general communicable diseases (deferred STD and TB to STD and TB Controllers respectively)- It is important to note, that based on multiple program

responsibilities some responders included TB and STD in the ranking of their top ten CD priorities in the first survey

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SCOPE OF RESPONSIBILITIES FOR CD CONTROLLERS

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METHODS

• The literature was reviewed to identify guiding principles in the control of communicable diseases

• CD Controllers were surveyed and asked to identify their top ten CD priorities and guiding principles

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METHODS (cont.)

• A matrix was developed which divided jurisdictions by population size:– < 100,000 – 100,000 – 400,000– >400,000

• The findings from the literature review and results of the surveys provided the foundation for CD Prioritization Matrix/Template

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GUIDING PRINCIPLES

• Availability of a Public Health intervention (e.g., treatment, PEP, vaccination)

• Effectiveness, cost, feasibility of available Public Health interventions

• The capacity to respond (staff and/or supplies)• *Public Health burden of the disease

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GUIDING PRINCIPLES (cont.)

– *Morbidity/mortality– *Incidence

• Epidemiologic characteristics (outbreak potential; changing disease trend)

• Public disruption (social and economic impact)• Political implications(potential to drive public

policy; public perceptions)

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FINDINGS• Forty-six percent of California’s jurisdictions responded to the

survey.• These jurisdictions account for 25.4 million California

residents.• Approximately 87% of responding jurisdictions indicated that

they had developed a prioritization process.– Of these, 86% indicated it was based on the urgency of the reported

disease/condition - Title 17, section 2500, 2505.

• Approximately 92% of responding jurisdictions indicated that budget and/or staffing reductions had impacted their ability to carry out CD control functions.

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EXAMPLES OF BUDGET IMPACT

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EXAMPLES OF MORE EFFICIENT METHODS

• Increase use of letters and phone calls• Reduced number of attempts to contact

patient• Use of syndromic surveillance to identify

clusters

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CD SURVEY RESPONSES< 100,000

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CD SURVEY RESPONSES< 100,000 (cont.)

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CD SURVEY RESPONSES 100,000 – 400,000

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CD SURVEY RESPONSES 100,000 – 400,000 (cont.)

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CD SURVEY RESPONSES > 400,000

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CD SURVEY RESPONSES> 400,000 (cont.)

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DISCUSSION • Utilization of the matrix to systematically review and

document prioritization of core CD control activities • Evaluation of the matrix• Limitations of the Prioritization Matrix:

– Reflects responses from only 46% of California jurisdictions

– The number of responses for each population size is small

– The > 400,000 population category has a very large range and includes jurisdictions with one million population and higher

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DISCUSSION (cont.)

– Responses are from a specific point in time – communicable disease issues are dynamic, not static, rankings may change over time

• Phase two of the Prioritization Project– Formed workgroup to make recommendations for

streamlining CD investigation forms– CDPH: DCDC; CDER and IZ Branches are also

reviewing the forms

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Summary

• Prioritizing core CD control activities is essential in the era of diminishing resources

• Each jurisdiction must identify mission critical activities to protect our communities

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ACKNOWLEDGMENTS

Special Thanks to:

• David Dassey, LA County Dept. of Public Health• Michael Tormey, LA County Dept. of Public Health• Sara Cody, Santa Clara County Dept. of Public Health• Duc Vugia, CDPH• Kathleen Harriman, CDPH• Other CDPH staff who participated on the conference calls• Local Health Jurisdictions that participated on the conference

calls• Local Health Jurisdictions who completed the survey

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