Worth It? Quantifying the Value of Healthcare Preparedness Using the National Health Security Index
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1 University of Kentucky From the SelectedWorks of Glen Mays Summer June 14, 2017 Worth It? Quantifying the Value of Healthcare Preparedness Using the National Health Security Index Glen P. Mays, University of Kentucky Available at:
2 Worth It? Quantifying the Value of Healthcare Preparedness Using the National Health Security Index Glen Mays, PhD, MPH, University of Kentucky Suzet McKinney, DrPH, MPH, Illinois Medical District Commission Robert Burhans, Emergency Management
3 Why a Health Security Index? Track national progress in health security as a shared responsibility across sectors Identify strengths and vulnerabilities Detect gains and losses Encourage coordination & collaboration Facilitate planning & policy development Support benchmarking & quality improvement Stimulate research & innovation
4 A Brief History / /2014 1/2015 4/2016 4/2017 Collaborative Development: CDC, ASTHO and >25 collaborating organizations 1 st Release: Initial model structure and results 5 domains and 14 subdomains 128 measures 2 nd Release: Revised model and results 6 domains and 18 active subdomains Measures: 119 retained + 75 new = 194 measures Transition to Robert Wood Johnson Foundation Validation studies and revision to methodology & measures 3 rd Release: Revised model and results 6 domains & 19 active subdomains Measures: 65% retained, 12% respecified, 8 new = 135 total Valid comparisons over time + confidence intervals 4 th Release: Refined model and results Added District of Columbia Measures: 4 dropped, 7 respecified, 8 new =139 total
5 What the Index measures
6 Enhanced Methodology 139 individual measures 19 subdomains 6 domains Weighted average Weighted average Weighted average State overall values Unweighted average National overall values Normalized to 0-10 scale using min-max scaling to preserve distributions Imputations based on multivariate longitudinal models Empirical weights based on Delphi expert panels Bootstrapped confidence intervals reflect sampling and measurement error Annual estimates for Reliability by Domain Alpha Health security surveillance Community planning & engagement Incident & information management Healthcare delivery Countermeasure management Environmental/occupational health 0.749
7 2017 Results Steady but slow progress *statistically significant change
8 2017 Results The U.S. improved in most domains during , except healthcare delivery and environmental health *statistically significant change
9 2017 Results Geographic disparities in health security are large and persistent Above average Within average Below average %Increase in year %Decrease in year
10 % Change from Improvements occurred across the U.S., but 12 states trailed or lost ground AK Below national average AZ AL NV LA GA MS HI SC WY OK SD MT ID IN OH TX AR NM KS 2017 Results Within national average Above national average WV MI CA KY TN IL NJ ND FL PA MO DC IA CO WA DE OR UT NC MA MN CT NH WI ME NE NY VA RI MD VT Index Value
11 2017 Results Changes vary widely across states and domains Lowest State US Average Highest State Index Values in 2013 and 2016
12 2017 Results Health security tracks closely with social & economic determinants of health Poverty Rate AK AZ AL MS LA GA NM AR KY FL NC TX OK SC WV KS TN NY SD CA OH IN NV MI ID PA ME MT OR RI MA NJ WA WI HI IL DE ND VA IA NE WY MO CO MD UT CT MN NH VT Percent of population below federal poverty threshold Index Value Percent of population without health insurance coverage Uninsured Rate AK AZ TX GA MS OK FL NM NV AL LA SC ID TN NC KS MT UT WY SD IN AR MO CO VA CA NJ ND NE WADE OR WI MD OH KY MI WVIL PA CT MNNY HI IA NH ME RI VT Index Value DC MA
13 2017 Results Racial and ethnic inequities in health security Percent of population residing in a state with below-average health security Relative Risk: 21%* 8% 38%* *statistically significant difference
14 2017 Results Rural-Urban differences in health security Percent of population residing in a state with below-average health security Relative Risk: 23%* *statistically significant difference
15 2017 Results Underlying drivers: occupational Percent of workers with paid sick leave and telecommuting opportunities * * *statistically significant change
16 2017 Results Underlying drivers: organizational Participation in Healthcare Preparedness Coalitions
17 2017 Results Underlying drivers: community and systems Communities with Strong Multi-Sector Networks (Comprehensive Public Health Systems) *statistically significant difference
18 Closing gaps and inequities: Insights from the Index Build & connect existing networks and coalitions Engage the private sector Focus on low-resource states & settings Focus on stagnant and declining domains: healthcare & environmental Include insurance coverage as a security strategy Allow for flexibility in allocation and use of resources
19 Caveats and cautions Imperfect measures & latent constructs Missing capabilities Timing and accuracy of underlying data sources
20 Using the Index for Healthcare Preparedness Suzet McKinney, DrPH, MPH Illinois Medical District Commission
21 Using the Index for Healthcare Preparedness Robert Burhans Emergency Management Consultant
22 On the horizon Webinar series on Index use Preparedness Innovator Challenge Exploratory work to include territories and sub-state metropolitan areas Analyses to uncover causes and consequences of change in health security To receive updates from the Health Security Index, with Subscribe NHSPIndex in the body
23 National Advisory Committee Members Thomas Inglesby, MD (Chair), Johns Hopkins University Robert Burhans, Health Emergency Management Consultant Anita Chandra, DrPH, RAND Mark DeCourcey, U.S. Chamber of Commerce Foundation Eric Holdeman, Emergency Management Consultant Harvey E. Johnson, Jr., American Red Cross Ana Marie Jones, Interpro Dara Lieberman, MPP, Trust for America s Health Nicole Lurie, MD, MSPH, ASPR (through 1/2017) Suzet McKinney, DrPH, MPH, Illinois Medical District Commission Stephen Redd, MD, CDC Office of Public Health Preparedness & Response Richard Reed, MSW, American Red Cross (through 2/2016) John Wiesman, DrPH, MPH, Washington State Secretary of Health Special appreciation to Index collaborators at CDC, ASPR, ASTHO, APHL, NACCHO, RAND, members of the Model Design and Analytic Methodology Workgroup, and the Stakeholder Engagement and Communications Workgroup. Visit or join an Index workgroup at
24 For More Information National Program Office Supported by The Robert Wood Johnson Foundation Web: Glen P. Mays, Ph.D., M.P.H. Archive: works.bepress.com/glen_mays Blog: publichealtheconomics.org To receive updates from the Health Security Index, with Subscribe NHSPIndex in the body National Coordinating Center
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