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Since 2001, the U.S. Department of Health and Human Services (HHS) has made significant investments in state and local public health in an effort to enhance public health emergency preparedness. The RAND Corporation was contracted to work with the HHS Office of Public Health Emergency Preparedness (OPHEP) to develop resources and prepare analyses to help describe and enhance key aspects of state and local public health emergency preparedness (PHEP). This report describes work done on the task to develop a framework for applying quality improvement (QI) in public health and to investigate the applicability of those models to PHEP and, specifically, to address the following questions: (1) Are there examples of QI in public health, and what can be learn from them for PHEP? (2) What organizational and contextual factors facilitate QI, and what are the implications for PHEP? and (3) How can public health leaders implement and accelerate QI as it relates to PHEP? To answer these question, we identified public health departments that were nominated as having promising practices with respect to QI overall and in PHEP in particular; performed site visits with interviews at a subset of these sites (interviews were conducted by telephone at two of the nine sites); and drew themes from our interview notes. Among the resulting recommendations were that attention needs to be paid to organizational development and changes, and that PHEP and QI for PHEP will be most successful when integrated into routine public-health practice and into daily work.

Table of Contents

  • Chapter One


  • Chapter Two

    Approach for Applying Quality Improvement in Public Health Emergency Preparedness

  • Chapter Three

    Examples of Quality Improvement in Public Health Emergency Preparedness

  • Chapter Four

    Overarching Themes and Recommendations

  • Appendix A

    Quality Improvement Components and Contextual Factors

  • Appendix B

    Methodology for Site Visits

  • Appendix C

    Screening Interview Protocol

  • Appendix D

    Site Visit Interview Protocol

The research described in this report was prepared for the U.S. Department of Health and Human Services. This research was produced within RAND Health’s RAND Center for Domestic and International Health Security. RAND Health is a division of the RAND Corporation.

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