An Economic Analysis and Approach for Health Care Preparedness in a Substate Region.

OBJECTIVE: To demonstrate the application of economics to health care preparedness by estimating the financial return on investment in a substate regional emergency response team and to develop a financial model aimed at sustaining community-level disaster readiness. METHODS: Economic evaluation methods were applied to the experience of a regional Pennsylvania response capability. A cost-benefit analysis was performed by using information on funding of the response team and 17 real-world events the team responded to between 2008 and 2013. By use of the results of the cost-benefit analysis as well as information on the response team's catchment area, a risk-based insurance-like membership model was built. RESULTS: The cost-benefit analysis showed a positive return after 6 years of investment in the regional emergency response team. Financial modeling allowed for the calculation of premiums for 2 types of providers within the emergency response team's catchment area: hospitals and long-term care facilities. CONCLUSION: The analysis indicated that preparedness activities have a positive return on their investment in this substate region. By applying economic principles, communities can estimate their return on investment to make better business decisions in an effort to increase the sustainability of emergency preparedness programs at the regional level.

Health system preparedness for bioterrorism: bringing the tabletop to the hospital.

OBJECTIVE: To evaluate the acceptance and usefulness of a hospital-based tabletop bioterrorism exercise. DESIGN: A descriptive study of responses to a smallpox scenario delivered as a tabletop exercise in three modules. SETTING: A large, multi-institutional urban health system. PARTICIPANTS: Healthcare workers representing 16 hospital departments. RESULTS: Thirty-nine (78%) of 50 invited employees from 4 hospitals participated. Key responses highlighted the importance of pre-event planning in intra-departmental communication, identification of resources for the dependents of healthcare workers, clarification of the chain of command within the hospital, establishment of a link to key governmental agencies, and advanced identification of negative pressure rooms for cohorting large numbers of patients. Almost one-fourth of the participants described their hospital department as poorly prepared for a bioterrorism event of moderate size. At the conclusion of the tabletop, 79% of the participants stated that the exercise had increased their knowledge of preplanning activities. Seventy-nine percent of all participants, 94% of physicians and nurses, and 95% of participants from non-university hospitals ranked the exercise as extremely or very useful. The exercise was completed in 3 1/2 hours and its total direct cost (excluding lost time from work) was 225 dollars (U.S.). CONCLUSIONS: Tabletop exercises are a feasible, well-accepted modality for hospital bioterrorism preparedness training. Hospital employees, including physicians and nurses, rank this method as highly useful for guiding preplanning activities. Infection control staff and hospital epidemiologists should play a lead role in hospital preparedness activities. Further assessment of the optimal duration, type, and frequency of tabletop exercises is needed.