Executive Summary

The Healthcare Facilities Partnership Program and Emergency Care Partnership Program Evaluation Report PDF
   

Introduction

The Center for Biosecurity (the Center) was asked by the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the U.S. Department of Health and Human Services (HHS) to evaluate the Healthcare Facilities Partnership Program (HFPP) and the Emergency Care Partnership Program (ECP), both of which were funded through competitive grants in FY2007–FY2008.1,2

The goal of the evaluation was to assess the effectiveness, efficiency, and impact of the partnership programs for the purpose of informing future funding and support for the development of healthcare partnerships throughout the United States. In so doing, this evaluation identifies key accomplishments of and lessons learned by the partnerships as they worked to improve preparedness and response efforts in their communities.

This Partnership Evaluation Report: Healthcare Facilities Partnerships & Emergency Care Partnerships (Partnership Evaluation Report) does not provide a detailed evaluation of the outcome of each individual partnership grant, since site visit reports and evaluations of the project outcomes have already been performed by project officers and ASPR program leadership. Rather, this report is intended primarily for use by ASPR and HHS in assessing the effectiveness of the partnership programs and the direct grant funding mechanism.

Methodology

The Center project team reviewed all relevant documents provided by ASPR leadership and evaluation groups, and by the HFPP and ECP grantees, including the following:

  • Original grant guidance

  • All successful original applications

  • Partnership mid-year self-assessments

  • Site visit reports prepared by ASPR project officers

  • Grantee program websites.

Following the document review and discussions with ASPR leadership, the Center project team conducted a preliminary evaluation to explore strengths and weaknesses of the direct partnership funding approach. Case studies of the King County Healthcare Coalition and the Healthcare Facilities Partnership of South Central Pennsylvania were conducted, and the resulting report was delivered in February 2008 to provide ASPR leadership with an initial impression of the program overall and the direct grant funding mechanism specifically.

The Center’s project team then conducted interviews with program leaders at ASPR, principal investigators (PIs) from each of the remaining partnerships, state Hospital Preparedness Program (HPP) coordinators, and other state officials. Site visits werse conducted at 8 of the 11 HFPP partnerships and at each of the 5 ECP partnerships. Ahead of each site visit, the project team held conference calls with partnership PIs to exchange information about the evaluation effort and the partnership program and to develop an agenda for the site visit.

Key Questions about the Partnerships

Conversations held during conference calls and site visits focused on a series of questions that addressed the following broad topics:

  • Organization and establishment of the partnerships

  • Projects funded by the HFPP and ECP grants and resulting accomplishments

  • Relationship between partnership grant and the state HPP

  • Advantages and/or disadvantages of the direct grant funding approach

However, not all of the key questions were addressed in every discussion, and discussions were not limited to addressing these questions.

Overview of Partnerships

Tables 1 and 2, below, summarize key details about each of the 10 HFPP grantees and the 5 ECP grantees. Noted for each is the name of the partnership, location, lead agency or organization (the grantee), at least 1 unique outcome of the grant program, and 1 or more important lessons learned. (Detailed profiles of each partnership begin on page 13.)

Table 1: Overview of Healthcare Facilities Partnership Program (HFPP)
HFPP Partnership: Lead Agency/Org., Grant Funding, Unique Outcome and Lesson(s) Learned

Alaska Healthcare Facilities Partnership (Anchorage, AK)

LEAD AGENCY/ORGANIZATION:
Alaska Department of Health and Social Services

GRANT: $742,000

UNIQUE OUTCOME:
Increased pediatric surge capacity across the state.

LESSONS LEARNED:
(1) Focus on priority already identified by state HPP contributed to the success and sustainability of the program. (2) HPP funds to support the program in the future.

Massachusetts Partnership for Effective Emergency Response [PEER] (Boston, MA)

LEAD AGENCY/ORGANIZATION:
Massachusetts Emergency Preparedness Regions 4 A, B, C, with the Boston University School of Public Health

GRANT: $2.4 MILLION

UNIQUE OUTCOME:
Strengthened integration and communication in 3 public health regions.

LESSONS LEARNED:
HFPP mechanism, time, and scale were not sufficient for developing and completing a new partnership in multiple jurisdictions.

Broward County Healthcare Coalition [BCHC] (Fort Lauderdale, FL)

LEAD AGENCY/ORGANIZATION:
North Broward Hospital District

GRANT: $426,000

UNIQUE OUTCOME:
Developed Internet-based communication and situational awareness system.

LESSONS LEARNED:
(1) HPP funding created a regional gap, the solution for which was an HFPP-funded regional program. (2) New system to be used in daily routine and during emergencies.

Minnesota Metropolitan Hospital Compact (Minneapolis, MN)

LEAD AGENCY/ORGANIZATION:
Hennepin Healthcare System Minneapolis

GRANT: $2.5 million

UNIQUE OUTCOME:
Developed mobile medical assets under joint authority with the state.

LESSONS LEARNED:
(1) Grant programs were facilitated by a preexisting regionalized system. (2) State and local coordination ensures sustainability.

Charleston—Roper St. Francis Foundation (Charleston, SC)

LEAD AGENCY/ORGANIZATION:
Roper St. Francis Foundation

GRANT: $2.5 million

UNIQUE OUTCOME:
Established caches of supplies and mobile inland shelters.

LESSONS LEARNED:
(1) The grant mechanism was effective for funding important local project derived from hazard vulnerability analysis (HVA).
(2) The program will be sustained through an ongoing regional healthcare council.

New York State—New York Burn Partnership (New York)

LEAD AGENCY/ORGANIZATION:
New York State Department of Health

GRANT: $2.5 million

UNIQUE OUTCOME:
Close integration with state HPP goals enhanced effectiveness.

LESSONS LEARNED:
Program can be sustained.

City and County of San Francisco Partnership (San Francisco, CA)

LEAD AGENCY/ORGANIZATION:
San Francisco City and County Community Hub Plan

GRANT: $787,000

UNIQUE OUTCOME:
Developed innovative disaster response plan based on “hub site” model.

LESSONS LEARNED:
Review and restructuring of entire response system would not have been possible with HPP funds alone.

Rural Nebraska Medical Response System (Elkhorn, NE)

LEAD AGENCY/ORGANIZATION:
Elkhorn Logan Valley Public Health Department

GRANT: $868,000

UNIQUE OUTCOME:
Developed partnership covering large geographic area and used telehealth network.

LESSONS LEARNED:
Partnership, state programs, and preexisting infrastructure were closely linked, and made the grant successful and sustainable.

Healthcare Facilities Partnership of South Central Pennsylvania (Hershey, PA)

LEAD AGENCY/ORGANIZATION:
Pennsylvania State University Hershey Medical Center

GRANT: $2.5 million

UNIQUE OUTCOME:
Developed webinar system for enhanced communication, situational awareness, education, and training using simulation modules.

LESSONS LEARNED:
(1) Emergency communications among partnership institutions was significantly enhanced. (2) Need to fully link to jurisdictional emergency response agencies.

WakeMed Project Modeling Via Evacuation Scenarios [MoVES] (Raleigh, NC)

LEAD AGENCY/ORGANIZATION:
WakeMed Health Care System

GRANT: $1 million

UNIQUE OUTCOME:
Focused on evacuation based on local Hazard Vulnerability Analysis (evaluation in progress).

LESSONS LEARNED:
The preexisting regional system for HPP and trauma facilitated the HFPP.

King County Healthcare Coalition (Seattle, WA)

LEAD AGENCY/ORGANIZATION:
King County Healthcare Coalition

GRANT: $1.9 million

UNIQUE OUTCOME:
Added non-hospital agencies and providers to partnership and Emergency Support Function #8 (ESF-8) response.

LESSONS LEARNED:
(1) Direct grant allowed for more freedom to expand scope of coalition.
(2) Sustainability is a consideration.

  

    

Table 2: Overview of Emergency Care Partnership Program (ECP)
ECP Partnership: Lead Agency/Org., Grant Funding, Unique Outcome & Lessons(s) Learned

Davis California Enhancing Surge Capacity and Partnership Effort (ESCAPE) Partnership (Davis, CA)

LEAD AGENCY/ORGANIZATION:
Regents of the University of California, Davis

GRANT: $5 million

UNIQUE OUTCOME:
Developed telemedicine system for improved daily and surge event emergency and critical care, with a particular focus on rural facilities, and developed crisis care guidelines.

LESSONS LEARNED:
Rural healthcare facilities have unique needs and can greatly benefit from partnership participation and telemedicine systems.

Los Angeles Partnership—Pediatric Disaster Resource and Training Center
(Los Angeles, CA)

LEAD AGENCY/ORGANIZATION:
Children’s Hospital Los Angeles

GRANT: $5 million

UNIQUE OUTCOME:
Developed pediatric disaster courses (in-person and online), training, and drills/exercises; developed family reunification recommendations; and established telemedicine system using robots.

LESSONS LEARNED:
System or network should be developed by HHS for dissemination of key ECP deliverables.

District of Columbia Emergency Healthcare Coalition (Washington, DC)

LEAD AGENCY/ORGANIZATION:
MedStar Health, Inc., Washington Hospital Center

GRANT: $5 million

UNIQUE OUTCOME:
Integrated partnership into jurisdictional response system with Healthcare Coalition Response Team.

LESSONS LEARNED:
(1) Close integration with DC Department of Health and HPP goals enhance effectiveness. (2) Program to be continued.

Rhode Island Partnership (Providence, RI)

LEAD AGENCY/ORGANIZATION:
Rhode Island Hospital

GRANT: $5 million

UNIQUE OUTCOME:
Developed novel interoperable communication system.

LESSONS LEARNED:
Direct funding of the partnership through the largest institution as grant administrator created some concern from state’s smaller hospitals.

Indianapolis Managed Emergency Surge for Healthcare(MESH) Partnership (Indianapolis, IN)

LEAD AGENCY/ORGANIZATION:
Health and Hospital Corporation of Marion County

GRANT: $5 million

UNIQUE OUTCOME:
Established emergency communications center and training program and held tabletop exercises for region.

LESSONS LEARNED:
Direct grant mechanism requires close coordination with state.

 

    
Partnership Evaluation Report Conclusions and Recommendations

Conclusions: Healthcare coalitions and partnerships recently have emerged across the country, and, in practical application, have proven effective for integrating public health and medical emergency planning and response activities.3 Most recently, healthcare coalitions have been integral in the response to the 2009 H1N1 pandemic (see page 45).

The project team’s discussions with HFPP and ECP grant recipients uncovered several important, recurring themes, many of which are related to the direct grant funding mechanism used for the HFPP and ECP programs. When the grants support the growth and development of preexisting healthcare coalitions, the benefits of the direct funding approach outweigh the disadvantages: direct funding of existing successful partnerships allows for innovation, regional replication of projects, and expansion of healthcare coalitions to include non-hospital entities.

Several caveats were noted: (1) direct grant funding of partnerships must be coordinated with the mission and priorities of a state HPP program, even if a partnership works on projects other than those prioritized by the state; and (2) successful functioning of partnerships and completion of grant deliverables depends on a formal partnership governance structure, or an informal structure backed by memoranda of understanding (MOU) or memoranda of agreement (MOA) among member institutions and agencies.

The direct grant funding mechanism did present significant administrative challenges for both established and emerging partnerships. And sustainability of grant-funded efforts is a challenge for all grantees, although several partnerships factored sustainability into their grant activities and have begun to plan for the continuation of their organization’s efforts beyond the grant period.

Recommendations: The success of the HFPP and ECP programs suggests that federal programs that support the development of functional capabilities of healthcare coalitions should continue, but with several changes and additions. For instance, the periods of time between announcements of grants, issuance of guidance, and submission deadlines should be increased significantly. Grant requirements should be expanded to include a specific plan to sustain both the partnership structure and functional capabilities achieved through the grant funding. In addition, sustainability plans should address integration of partnership projects into overall programs for state and local preparedness and response. As well, partnership grant projects should formalize real-time exchange of information and experience through the use of social media, websites, and face-to-face conferences facilitated by ASPR leadership.

HPP guidance should continue to emphasize the importance of functional healthcare coalitions and should address requirements, criteria, and essential features of healthcare coalitions. In regions where there is no experience with basic, functional healthcare coalitions, the 1-year direct partnership grants should not be used to stimulate development of new coalitions. Finally, other models that support the development and expansion of functional capacities of healthcare coalitions should be considered, including the Advance Practice Center (APC) model (Centers for Disease Control and Prevention [CDC]) and a healthcare coalition “mentorship” program.

References

  1. U.S. Department of Health and Human Services. HHS awards healthcare facility partnership program. [news release]. September 27, 2007. http://www.hhs.gov/news/press/2007pres/09/pr20070927c.html. Accessed October 26, 2009.

  2. U.S. Department of Health and Human Services. HHS awards $25 million in healthcare partnership emergency. [news release]. September 27, 2007. http://www.hhs.gov/news/press/2007pres/09/20070927a.html. Accessed October 26, 2009.

  3. See Center for Biosecurity . Hospitals Rising to the Challenge: The First 5 Years of the Hospital Preparedness Program and Priorities Going Forward. Prepared for the U.S. Department of Health and Human Services under Contract No. HHSO100200700038C. March 2009.


   


Project Team: Center for Biosecurity

Eric Toner, MD, Principal Investigator
Senior Associate

Richard E. Waldhorn, MD, Co-principal Investigator
Distinguished Scholar

Crystal Franco, MPH, Project Manager
Senior Analyst

Ann Norwood, MD, COL, USA, MC (Ret.)
Senior Associate

Brooke Courtney, JD, MPH
Associate

Kunal Rambhia
Analyst

Matthew Watson
Analyst

Thomas V. Inglesby, MD
Director and Chief Executive Officer