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Mounting an effective emergency response to a public health threat, such as a pandemic influenza, is a common challenge of state and local public health agencies across the country. A quality improvement (QI) approach is a data-driven, systematic approach to organizational change; it can provide a comprehensive way to assess current performance, identify shortfalls and solutions, and implement changes (improvements) in public health emergency preparedness (PHEP).

The PREPARE for Pandemic Influenza: A Quality Improvement Toolkit is intended to help state and local health departments of all sizes incorporate QI methods and promising improvement strategies into their current emergency preparedness activities. This toolkit was developed with the input of health departments from across the country, including those who participated in the 2006–2007 PREPARE [Promoting Emergency Preparedness and Readiness] for Pandemic Influenza (PI) Quality Improvement learning collaborative.

The toolkit provides a brief tutorial on using QI methods for public health emergency preparedness. The core of the toolkit suggests performance aims and offers measures, tools, and improvement ideas related to six key preparedness domains:

  • surveillance
  • case reporting and investigation
  • command and control
  • risk communication
  • disease control
  • disease treatment.

Unlike other PHEP improvement approaches, the toolkit focuses on building agency capabilities rather than assessing agency capacity for future action. Also emphasized are efforts that improve both day-to-day public health activities and preparedness.

If you would like a free copy of the entire Quality Improvement Toolkit on CD-ROM, please send your name, organization and address to and enter “Requesting the PREPARE Toolkit” in the subject line.


Please Note: The individually downloaded chapters will have limited functionality. You will not be able to jump from chapter to chapter using the navigation panel or link to the Appendix section from other chapters.


Preface (12.8 MB)

Chapter 1

Chapter 1 (13.5 MB)


Chapter 2

Chapter 2 (16.7 MB)

The PREPARE Approach for QI in PHEP

Chapter 3

Chapter 3 (21.9 MB)

Implementing the PREPARE Approach to QI in PHEP

Chapter 4

Chapter 4 (73.2 MB)

Strategies and Tools for Improvement

Chapter 5

Chapter 5 (13.8 MB)

Support from Leadership for QI in PHEP


Appendix (54.5 MB)

References, Glossary, Resources, Acknowledgements


The PREPARE for Pandemic Influenza collaborative and toolkit are projects within the RAND program for Public Health Preparedness within RAND Health, a division of the RAND Corporation. Funding for these projects came from the Robert Wood Johnson Foundation and the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary of Preparedness (ASPR).

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