Health Center Survey and Interviews

The Hospital Preparedness Program

0990-0391 ASPR TRACIE Health Center Attachment A - Survey_5_17_18

Health Center Survey and Interviews

OMB: 0990-0391

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Attachment A: ASPR TRACIE Health Center Survey


Consent

The US Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) is conducting research on the role of Health Centers in supporting the health and medical response to disasters or emergencies.

ASPR TRACIE recognizes your Health Center complies with Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule. The purpose of this survey is to better understand Health Centers’ capacity, preparedness, and impediments in disaster response beyond those requirements.

Your participation in this survey is completely voluntary. You may choose not to participate or to end the survey at any time. We will keep your responses confidential, and unless you wish to participate in a follow-up phone interview, we will not ask for any personal information such as your name or email address.

If you have any questions about the survey, please contact: askasprtracie@hhs.gov.

Please indicate whether or not you consent to participate in this survey:

  • Consent [proceed to question 1]

  • Do not consent [ineligible]









1. What is your role/position at your Health Center? Select all that apply.

Facilities Manager

Clinical Manager

Clinician

Emergency Preparedness Lead

Other (please describe)


Health Center’s Role in Emergency Response

Scenarios

For the next set of questions please consider the two different scenarios presented below:

An infectious disease outbreak is affecting your entire geographic region. Over an extended period of time, the number of infections will gradually increase, reach a peak, and begin to decrease. There will be high demands on the overall healthcare system, which will deal with patients infected with the disease and the worried well, on top of the normal range of healthcare services. There may be high demand and low availability of healthcare personnel, supplies, and other resources at varying points in time during the outbreak.

A sudden onset or no notice incident occurs in your community and possibly causes a patient surge or mass casualties. An incident such as a natural disaster or plant explosion suddenly results in large numbers of injuries with little or no warning. The healthcare system will absorb an immediate influx of patients with injuries of varying severity on top of its existing load of patients with chronic and acute illnesses and injuries. There may be infrastructure damage, security requirements, or communications breakdowns that challenge your response to the incident for an unpredictable amount of time due to electrical outages, telecommunications and IT system failure, supply chain disruptions, and reduced staffing.

Please select one answer for each scenario.


Infectious Disease Outbreak

Sudden Onset Incident

2. Based on your existing emergency plan and/or community partnerships, would your Health Center have a role in addressing healthcare needs caused by either of these scenarios?

Yes

No

Yes

No




For the next set of questions please consider the two scenarios presented above and your standard practice of care.


3. In which of the following ways are you contributing as standard practice OR could you contribute during an Infectious Disease Outbreak or a Sudden Onset/No Notice Incident (Select all that apply):


Standard Practice at your Health Center

Infectious Disease Outbreak

Sudden Onset Incident

Expertise in treating certain patient populations (e.g., children, older adults, homeless)

Additional surge capacity for patient treatment (i.e, ability to manage a sudden influx of patients including additional staff, space, equipment, medications, etc.)

Public health surveillance/monitoring

Patient triage

Patient/community education/risk communication

Prophylaxis/vaccination available – on site

Prophylaxis/vaccination available – off site

Trained and geographically accessible personnel to support a medical shelter

Trained and geographically accessible personnel to support an alternate care site

Location to establish a temporary medical station or triage site

Temporary safe haven from external threat (e.g., violence, weather)

Behavioral health support/treatment for patients (i.e., availability of staff with behavioral expertise in behavioral health management)

Behavioral health support/treatment for staff (e.g., providers, first responders)

Support for responder treatment/monitoring

Follow-up care during the recovery phase of the emergency

Other (please describe)






4. Which of the following might pose an obstacle or challenge to your involvement in the response?


Infectious Disease Outbreak

Sudden Onset Incident

Anticipated demand from existing patients

Lack of internal expertise for emergency management

Supplies and equipment likely needed for the scenario may not be available

Personnel may not be accessible

Location may be closed due to incident effects on personnel or infrastructure

Concerns about reimbursement for services provided during incident

Concerns about liability

Healthcare setting is inappropriate for the emergency response

Unsure of role/not engaged in community emergency planning for the response

Other (please describe)





5. What would initiate your involvement in the response?


Infectious Disease Outbreak

Sudden Onset Incident

Responding to meet the needs of your existing patients

New patients presenting to the health center for care

A request from a health system partner

A request from your health care coalition

A request from a local, state, or federal emergency management or public health agency

Other (please describe)




Health Center’s Infrastructure and Scope of Emergency Response

Please select one answer for each of the following questions.


Yes

No

I don’t know

6. Do you receive notifications about emergencies in your area from your local or state emergency management or public safety agency?

7. Do you receive health alerts from your local or state health department?

8. Would it be possible to modify your existing space to accommodate additional patients?

9. Do you have the ability to supplement your normal staffing levels to accommodate a surge?

10. Would you be able to extend your operating hours during an emergency?

11. Do you have designated disaster supplies on site or a standing inventory list with your supply vendor for items needed for emergency back-up that gets pulled automatically in the event of an emergency?

12. Do you provide information/resources to your patients to encourage their preparedness?

13. Have you participated in an emergency response in your community?

14. Have your operations been affected by an emergency in your community?

15. If yes to 13or 14 - Have you made any changes to your policies, procedures, or protocols based on the experience?

16. Does your Health Center have contingency plans to allow the rapid order/delivery of supplies (medical and hospitality-related supplies) if there is a need for support beyond current service provision capacity?

17. Does your Health Center have contingency plans to provide emergency transport to designated hospital or clinics in your area?


For the next set of questions please select the option that applies for normal operations and operations during an emergency at your Health Center.


18. Do you have any of the following in place to accept referrals of patients with minor illness or injury?


Normal Operations

During an Emergency

Established protocols as part of an integrated health care delivery system (i.e., a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population) or with EMS directly

Informal protocols based on others’ knowledge of your presence in the community

Established referral/transfer/patient distribution protocols or MOUs in the community



Emergency Preparedness: Procedures and Collaborations

Please select one answer for each of the following questions.

19. Do you participate in coordinated emergency preparedness activities with any of the following?


Yes

No

As part of a group of health care centers

Health care coalition

Health department

Emergency management agency

Non-profit organizations serving your community

Emergency relief organizations

Other (describe)


20. Have you tested your ability to implement the following either through an exercise or real-life incident?


Yes –through an exercise

Yes – through a real-life emergency

No

Contact personnel during off hours

Receive/send notifications to other preparedness/response partners

Identify and safely isolate a potentially infectious patient

Proper usage of personal protective equipment (PPE) by personnel for a potential highly infectious patient (e.g., Novel Influenza or Ebola)

Quickly establish a medical record for a patient who is not a pre-existing client

Maintain patient records (i.e., paper based) if electronic medical record (EMR) is inaccessible

Procedures to shut down facility operations

Procedure to restart operations

Conduct patient triage

Financial preparedness (e.g., maintaining cash reserves, planning for business interruptions and losses, insurance policies)

Establish incident command

Secure site/personnel safety

Respond to or protect facility during known threats (e.g., earthquake, hurricane)

Inform HRSA Bureau of Primary Care and/or state or local Health Department of changes in operations, such as operating a temporary site

Reach/maintain contact with patients while closed


Please select all the options that apply for each of the following questions.

21. How do/can potential partners in your community engage you in ongoing preparedness activities?


Select All that Apply

Direct contact

Through the local/state/regional primary care association

Through the integrated health care delivery system

Through health care coalitions

Through existing relationships

Other (please describe)


Please select all that apply for each type of emergency-related of activity.

22. Which of the following types of support would assist your participation in preparedness and response activities?


Preparedness Activities

Response Activities

Funding/reimbursement

Guidance/SME support/technical assistance

Access to supplies/equipment

Access to additional personnel

Access to additional training and exercises

Legal protections

Inclusion in notification/information sharing

Other (please describe)



Health Center Characteristics


23. In what state is your Health Center located?

DROP DOWN MENU


24. How would you describe the geographic setting of your Health Center?

Urban

Suburban

Rural

Geographically isolated/remote


25. What are your normal hours of operation?

Monday


Tuesday


Wednesday


Thursday


Friday


Saturday


Sunday




26. Which best describes the type of Health Center where you work?

Federally Qualified Health Center

Rural Health Clinic

Free and Charitable Clinic

Planned Parenthood Clinic


27. (IF Above = Federally Qualified Health Center) Which best describes the type of Federally Qualified Health Center where you work? (Select all that apply)

Community Health Centers

Migrant Health Centers

Health Care for the Homeless Health Centers

Public Housing Primary Care Centers

Health Center Program Look-Alikes

Outpatient Health Programs Facilities Operated by a tribe or tribal organization under the Indian Self-Determination Act or by an urban Indian organization under the Indian Health Care Improvement Act



28. Is your Health Center part of an Integrated Delivery System?

Yes

No

I do not know


29. Please indicate the type of practice that best describes your Health Center’s setting.

Your Health Center is the only practice on site

There are other specialty practices on site

Your Health Center is integrated within a hospital


30. Please select all the services that are provided at your Health Center. Select all that apply.

Care Coordination and Triage

Infectious Disease Monitoring

Behavioral/Mental Health Care

Oral Health

Vision Services

Urgent Care/Same Day Services

Clinical Laboratory

Social Services

Radiology Services

Home Health Services

Specialty Care

Immunizations

Pharmacy Services/Medication Access

Minor Trauma care (e.g., lacerations, minor orthopedic injuries)

Pediatric Services

Non-emergency Transportation


31. Please enter the number of staff available for each of the following specialties during normal operations and during an emergency.



Normal Operations

Primary Care Physicians


Physician Assistants


Specialty Care Physicians


Nurse Practitioner


Dental Personnel


Paramedic


Emergency Medical Technician (EMT)


Clinical Psychologist


Clinical Social Worker


Other Health Specialties


Administrative Staff


Volunteers (e.g., Medical Reserve Corps (MRC))


Other (please specify)



32. Is there anything else that you would like to share about the role of Health Centers in an emergency?








Yes

No

33. Would you be willing to participate in a follow-up discussion, scheduled at your convenience, to elaborate on some of your survey responses?


33.1 If yes, please provide your first name and email address:




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