CD PRIORITIZATION PROJECT SUMMARY REPORT NOVEMBER 1, 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 2

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 3

SCOPE OF RESPONSIBILITIES FOR CD CONTROLLERS 4

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 5

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 6

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 7

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) 8

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, Approximately 92% of responding jurisdictions indicated that budget and/or staffing reductions had impacted their ability to carry out CD control functions. 9

EXAMPLES OF BUDGET IMPACT 10

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 11

CD SURVEY RESPONSES < 100,000 12

CD SURVEY RESPONSES < 100,000 (cont.) 13

CD SURVEY RESPONSES 100,000 – 400,000 14

CD SURVEY RESPONSES 100,000 – 400,000 (cont.) 15

CD SURVEY RESPONSES > 400,000 16

CD SURVEY RESPONSES > 400,000 (cont.) 17

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 18

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 19

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 20

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 21