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An important component of the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) cooperative agreements for public health and hospital emergency preparedness has been to encourage linkages between local health departments and hospitals (as well as with other key stakeholders) to more effectively address different aspects of preparedness. Hospitals and public health departments have employed different approaches for doing so and have varied in their focus on such areas as patient treatment and infection control, quarantine and isolation procedures, disease surveillance and reporting, and/or risk communication.

In this study, we examine different models for coordination that local health departments and general acute-care hospitals have employed to improve public health preparedness. The study’s aims are to (1) describe those aspects of public health preparedness on which local health departments and hospitals are focusing their coordination efforts; (2) examine how these relationships have changed over time; (3) identify factors that facilitate or hinder coordination; (4) understand how funding affects coordination; (5) identify the mechanisms, policies, and procedures that have been demonstrated to be effective in coordinating the public health preparedness activities of local health departments and hospitals; and (6) suggest strategies to improve coordination between local health departments and hospitals and the integration of their preparedness activities. Key recommendations include critical success factors that local organizations can apply, as well as recommendations for state- and federal-level officials to facilitate coordination. For example, with regards to funding, CDC and HRSA cooperative-agreement programs need to be made more flexible in terms of who can receive the funding (the health department is not always the lead organization), what the money can be used for (now often a constraint at the local level that may fail to address activities that are most needed), and the time frame for use of the funds (so that monies are distributed in a more timely fashion).

The results will be of interest to the U.S. Department of Health and Human Services and to public health and medical professionals at the state and local levels who are responsible for improving public health preparedness and for ensuring collaboration among key stakeholders.

Table of Contents

  • Chapter One


  • Chapter Two

    Analytic Approach

  • Chapter Three

    Conceptual Framework

  • Chapter Four

    Survey Results

  • Chapter Five

    Case-Study Results

  • Chapter Six


  • Appendix

    Case-Study Protocol

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

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