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CALIFORNIA ASSOCIATION OF COMMUNICABLE DISEASE CONTROLLERS (CACDC). CD PRIORITIZATION PROJECT. SUMMARY REPORT NOVEMBER 1, 2012. OBJECTIVES. At the conclusion of this presentation participants will be able to:
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CALIFORNIA ASSOCIATION OF COMMUNICABLE DISEASE CONTROLLERS (CACDC) CD PRIORITIZATION PROJECT SUMMARY REPORT NOVEMBER 1, 2012
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
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
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
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
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
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)
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.
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
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
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
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
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