NHSPI™ Briefing for ASTHO/NEMA Workgroup - August 12, 2014

2014 Index Goals Produce Annual Index Improve the Index Expand the Index Engage and Communicate with Stakeholders Use the Index to Support the Science of Preparedness Transition of Index Ownership to Robert Wood Johnson Foundation 2014 NHSPI™ Activities: Produce Annual Index -Deliver a full product by the end of 2015 – from measure research, vetting, data updating to full model review to intensive stakeholder engagement. Anticipating a public release event in Washington DC in early December. Improve the Index -Through measure research and vetting, add new measures, replace weaker measures where possible, and update data as sources release new sets -Create new and improved materials based on stakeholder feedback Expand the Index -Enhance the Index through incorporating healthcare and environmental health more fully, resulting in the creation of a new domain and the addition of over 175 measures (final number still in process) Engage and Communicate with Stakeholders -Conduct outreach and seek collaboration with new and existing stakeholders, now expanded to include more environmental health partners and healthcare partners -Activities range from formal feedback gathering to presentation at key meetings to articles in industry newsletters, as well as an extensive search process to bring representatives from partner organizations to participate in the project on Workgroups and Task Forces -Beginning to Track, Understand, and Strengthen Index Use and Usefulness Use the Index to Support the Science of Preparedness -Form the Research Agenda Advancement Team, led by CDC’s Eric Carbone (DSLR) -Involve key players from RWJF and CDC in forward-thinking planning on research -Use funding opportunities to encourage schools of public health to embark on NHSPI™-related research, including validation of the Index Transition of Index Ownership to Robert Wood Johnson Foundation -From the NHSPI™’s inception, a transition to a permanent entity was planned -In-depth process undertaken to research and vet potential organizations to take ownership -RWJF is an excellent fit: credibility, experience with analogous work, fiscal capacity, philosophical alignment, commitment to preparedness and community resilience Activities for future years: 1. Integrate weighting of measures into the Index 2. Validation 3. Measures optimization (colinearity analysis) 4. Trend analysis 5. Systems dynamic model

2014 NHSPI™ Activities Maintain and Update Current Index 1. Maintain and Update Current Index 2. Measure Hunt to Expand the Index 3. Measure Details 4. Finalize and Perform Quality Control of Model for Transition 5. Communicate with Current Stakeholders 6. Engage with Current Stakeholders to Improve the Index 7. Engage New Stakeholders in Development of the NHSPI™ through SME Task Forces 8. Engage Current Stakeholders in Use and Usefulness 9. Advance Efforts with Key Organizations and Federal Partners 10. Use the Index to Support an Expanded Preparedness Research Agenda 11. Prepare for Transition to RWJF 12. Launch Preparation and Release of 2014 Index Activities for future years: Integrate weighting of measures into the Index Validation Measures optimization (colinearity analysis) Trend analysis Systems dynamic model Database solution

Timeline for 2014 Deliverables Launch Date: December 9 (tentative) State Preview Period and RWJF NPO Onboarding: November Model QC and Web Updates: October Model Finalization: September Measure Details and Continued Data Collection/Integration: August Stakeholder Feedback Review: July – August Stakeholder Feedback Review: July – August Measure Details and Continued Data Collection and Integration: August Model Finalization: September Model QC and Web Updates: October State Preview Period: November RWJF NPO Onboarding: November Launch Date: December 9

Model and Measure Activities Measure Hunt New Measures for 2014: Over 400 new measures identified and vetted 189 selected by Task Forces and Workgroup SMEs Final number of new measures may fluctuate slightly through data gathering and Measure Details process Existing Measures from 2013: 128 active measures 90 will be updated with new data 38 will remain without update These numbers are still tentative as we continue to work with chairs to reduce redundancies and identify measures that do not meet the sustainability criteria. 38 measures will not be updated this year. They come from the following sources: American Trauma Society, APHL, NASEMSO 2011 National Emergency Medical Services Assessment Report, HHS ESAR-VHP, WaterISAC, Epi-X and CDC School Health Policies and Practices Study. Measures not being updated will be reviewed to determine if they are becoming too outdated or the update frequency is not sufficient. Determinations will be made during the finalization of the model in September

2013 NHSPI™ Structure Figure illustrates the 2013 NHSPI™ The 2013 Index 5 Domains - 14 Sub-domains 128 Active Measures

Draft 2014 NHSPI™ Structure Changes The 2014 NHSPI™ will include both updated and new domains, sub-domains, and measures aimed at better reflecting the current cycle of preparedness, response, recovery, and mitigation. Structural Changes Include: Refinement of existing domains and sub-domains A new Environmental & Occupational Health domain Major revisions to the Healthcare Delivery domain (previously “Surge Management”) The 2014 NHSPI™ will include both model refinements and new measures. - Added one new domain with three sub‐domains Environmental & Occupational Health Responder Safety & Health Air, Food, & Water Security Human, Animal, and Environmental Monitoring & Decontamination - Revised the Surge Management domain and sub‐domains: Renamed Surge Management to Healthcare Delivery Renamed Emergency Medical Service to Prehospital Care Split Acute & Primary Care into two new sub‐domains; Inpatient Care, Outpatient Care Added Long‐Term Care and Home Care Removed Chronic & Long‐Term Care; measures for this sub‐domain have been moved to the Inpatient Care, Outpatient Care, Long‐Term Care, and Home Care sub‐domains - Moved Congregate Care sub‐domain to the Community Planning & Engagement domain - Added a Legal & Administrative sub‐domain to the Incident & Information Management domain - Moved Fatality Management from the Healthcare Delivery domain (previously “Surge Management”) to the Incident and Information Management domain. - Added a Non‐Pharmaceutical Interventions sub‐domain to the Countermeasure Management domain - Revised and / or developed definitions for Healthcare Delivery and Environmental & Occupational Health domains and sub‐domains

Draft 2014 NHSPI™ Structure Changes Figure illustrates the DRAFT 2014 NHSPI™ Structure Changes. The 2014 NHSPI™ will include both model refinements and new measures. The Draft 2014 NHSPI™ Structure as depicted above includes the following changes: - Added one new domain with three sub‐domains Environmental & Occupational Health Responder Safety & Health Air, Food, & Water Security Human, Animal, and Environmental Monitoring & Decontamination - Revised the Surge Management domain and sub‐domains: Renamed Surge Management to Healthcare Delivery Renamed Emergency Medical Service to Prehospital Care Split Acute & Primary Care into two new sub‐domains; Inpatient Care, Outpatient Care Added Long‐Term Care and Home Care Removed Chronic & Long‐Term Care; measures for this sub‐domain have been moved to the Inpatient Care, Outpatient Care, Long‐Term Care, and Home Care sub‐domains - Moved Congregate Care sub‐domain to the Community Planning & Engagement domain - Added a Legal & Administrative sub‐domain to the Incident & Information Management domain - Moved Fatality Management from the Healthcare Delivery domain (previously Surge Management) to the Incident and Information Management domain. - Added a Non‐Pharmaceutical Interventions sub‐domain to the Countermeasure Management domain - Revised and / or developed definitions for Healthcare Delivery and Environmental & Occupational Health domains and sub‐domains

Draft 2014 NHSPI™ Complete Structure Figure illustrates the DRAFT 2014 NHSPI™ Complete Structure – note that this is not the final structure – will continue to evolve in 2015 and beyond. Important to note in discussing this that like last year, not all subdomains will "light up" in 2014.

Built by the Community, for the Community Stakeholders will continue to shape the Index! Receive updates and share ideas at www.nhspi.org. Visit the website Join the NHSPI™ mailing list Ask questions nhspi-info@astho.org Call to Action… Explore the NHSPI with Others: What Influences Health Security Preparedness? What Can We Do Together to Advance It?