Explore the 2021 Index Release

Drawing data from 64 sources, the 2021 Release includes seven years of data from 2013 to 2020. The Index is the most comprehensive look at states' preparedness to date. It is also the first national index that looks at the nation’s health security by collectively measuring the preparedness of the states. States face varying threats, apply preparedness principles in locally relevant ways, and have unique interdependencies. The display of results on the Index website takes into account both preparedness and model complexities.

By Domain By State

Virginia

The overall preparedness level in Virginia stands at 7.4 for 2020. The national average is 6.8.

  • Virginia’s overall health security level reached 7.4 out of 10 in 2020, a 13.8% increase from 2013.
  • The overall health security level in Virginia was significantly above the national average health security level of 6.8 in 2020.
  • Virginia’s largest improvement occurred in the Community Planning & Engagement domain, which increased by 32.6% between 2013-20.
  • Health security levels in 2020 declined in no domains.
  • Health security levels in 2020 significantly exceeded the national average in 4 domains: Health Security Surveillance, Incident & Information Management, Health Care Delivery, and Environmental & Occupational Health.
  • Health security levels in 2020 were significantly below the national average in none of the six domains.
  • The state’s highest health security level in 2020 occurred in the domain of Incident & Information Management with a value of 9.7.
  • The state’s lowest health security level in 2020 occurred in Community Planning & Engagement Coordination with a value of 5.7.
7.4
6.8 National average
confidence interval 6.7 - 7.0
0 10
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2014
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2017
2018
2019
2020
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Select a state profile below
State Domain Scores

Health Security Surveillance

9.4
8.4 National average
0 10

NATIONAL CONFIDENCE INTERVAL: 8.2 - 8.7

Community Planning & Engagement Coordination

5.7
5.4 National average
0 10

NATIONAL CONFIDENCE INTERVAL: 5.1 - 5.7

Incident & Information Management

9.7
8.9 National average
0 10

NATIONAL CONFIDENCE INTERVAL: 8.7 - 9.1

Health Care Delivery

5.7
5.0 National average
0 10

NATIONAL CONFIDENCE INTERVAL: 4.8 - 5.2

Countermeasure Management

6.1
6.2 National average
0 10

NATIONAL CONFIDENCE INTERVAL: 5.9 - 6.6

Environmental & Occupational Health

7.8
6.9 National average
0 10

NATIONAL CONFIDENCE INTERVAL: 6.6 - 7.2

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Health Security Surveillance

phsei: health surveillance epidemiological investigation

bmlt: biological monitoring laboratory testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.

7.5
Measure
Measure Description
Score
m17
State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS).
Measure Name

M17

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.

Data date(s)

2012-2015

Limitations

The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.

Score

Foundational

m18
Number of epidemiologists per 100,000 population in the state, by quintile.
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction

Data date(s)

2012-2019

Limitations

The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

3.0

m19
State health department participates in the Epidemic Information Exchange (Epi-X) System.
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m20
State health department participates in the National Electronic Disease Surveillance System (NEDSS).
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013-2015

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m22
State health department has a syndromic surveillance system that can report and exchange information.
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012, 2016, & 2019

Limitations

Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.

Score

Yes

m217
State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies.
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m220
State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory.
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m256
State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet).
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

m23
Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed.
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

72.7%

m289
State health department participates in a broad prevention collaborative addressing health care associated infections (HAIs).
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.

Score

Foundational

m290
State has a public health veterinarian.
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015, 2017-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.

Score

Yes

m265
State uses an Electronic Death Registration System (EDRS).
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014-2018, 2020-2021

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.

Score

No

m801
State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network.
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.

6.9
Measure
Measure Description
Score
m1
Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise.
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2013

Limitations

The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.

Score

Foundational

m1314
State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA).
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results

Score

No

m208
State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service).
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m8
State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1).
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

No

m9
State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines.
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m11
State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours.
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

No

m12
State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory.
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.

Score

Yes

m211
Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella.
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

90.0%

m216
Percent of 15 to 21 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin-mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies. The 2018 CLSS survey added 6 more items (i.e., Ebola, Chikungunya, Zika, Lyme disease, Candida auris, and Mobilized colistin resistance (MCR 1)), increasing the total to 21 tests.
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

80.0%

m2
Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories.
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Laboratories may not undergo proficiency testing for all assay capabilities.

Score

100.0%

m3
Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.

Score

94.0%

m5
Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state's Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise.
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2013-2017

Limitations

The measure does not consider the public health laboratory's ability to process a large number of samples.

Score

50.0%

m7
Number of additional chemical agent detection methods-beyond the core methods-demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state.
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider all methods that the laboratory is capable of testing.

Score

4.0

m286
Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually.
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

4.0

m287
Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.

Score

92.0%

m288
Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state.
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.

Score

9.0

m911
State public health laboratory provides or assures testing for soil.
Measure Name

M911

Measure Source

Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m902
State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory).
Measure Name

M902

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)

Data date(s)

2016 & 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.

Score

Yes

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Community Planning & Engagement Coordination

cscc: cross sector community collaboration

arp: children other at risk populations

mvde: management of volunteers during emergencies

scc: social capital cohesion

This is best viewed on desktop.

The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.

2.3
Measure
Measure Description
Score
m87
State health department is accredited by the Public Health Accreditation Board (PHAB).
Measure Name

M87

Measure Source

Public Health Accreditation Board (PHAB), Health Departments in e-PHAB

Data date(s)

2013-2020

Limitations

The measure does not reflect health departments that are in process of achieving accreditation.

Score

No

m501
Percent of the state's population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems.
Measure Name

M501

Measure Source

National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.

Data date(s)

2012, 2014, 2016 & 2018

Limitations

Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.

Score

11.6%

m9031
Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9031

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

m9032
Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9032

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

1.6%

m9033
Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9033

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

5.0%

m9034
Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9034

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

28.6%

Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.

6.3
Measure
Measure Description
Score
m163
Number of pediatricians per 100,000 population under 18 years old in the state.
Measure Name

M163

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.

Score

80.3

m164
Number of obstetricians and gynecologists per 100,000 female population in the state.
Measure Name

M164

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.

Score

25.3

m170
Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers.
Measure Name

M170

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.

Score

96.6%

m53b
Percent of youth who missed one or more days of school in past month due to concerns about safety.
Measure Name

M53B

Measure Source

Youth Risk Behavior Survey

Data date(s)

2011, 2013, 2015, 2017 & 2019

Limitations

The measure is self-reported and does not distinguish reasons for safety concerns.

Score

5.5%

The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.

3.3
Measure
Measure Description
Score
m36
State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry.
Measure Name

M36

Measure Source

Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Data date(s)

2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.

Score

Foundational

m266
Percent of the state's population who live in a county with a Community Emergency Response Teams (CERT).
Measure Name

M266

Measure Source

Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016

Limitations

The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.

Score

66.1%

m346
Number of total Medical Reserve Corps members per 100,000 population in the state.
Measure Name

M346

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).

Score

14.2

m176
Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state.
Measure Name

M176

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.

Score

6.0

m179
Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state.
Measure Name

M179

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.

Score

46.5

m186
Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state.
Measure Name

M186

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.

Score

106.2

The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.

4.4
Measure
Measure Description
Score
m175
Percent of voting-eligible population in the state participating in the highest office election .
Measure Name

M175

Measure Source

United States Election Project, General Election Turnout Rates

Data date(s)

2012, 2014, 2016, 2018 & 2020

Limitations

The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).

Score

66.1%

m188
Percent of adults in the state who volunteer in their communities
Measure Name

M188

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.

Score

28.5%

m189
Number of annual volunteer hours per state resident, 15 years and older.
Measure Name

M189

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.

Score

33.7

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Incident & Information Management

incm: incident management

infm: information management

This is best viewed on desktop.

The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.

9.9
Measure
Measure Description
Score
m10
State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners.
Measure Name

M10

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2016

Limitations

The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.

Score

Foundational

m84
State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP).
Measure Name

M84

Measure Source

Emergency Management Accreditation Program (EMAP), Who Is Accredited?

Data date(s)

2014-2020

Limitations

The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.

Score

Yes

m107
Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii.
Measure Name

M107

Measure Source

National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments

Data date(s)

2013 & 2016

Limitations

The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.

Score

100.0%

m229
State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency.
Measure Name

M229

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.

Score

Foundational

m150
State uses a system for tracking hospital bed availability during emergencies.
Measure Name

M150

Measure Source

Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program

Data date(s)

2012-2018

Limitations

The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.

Score

Foundational

m701
Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty.
Measure Name

M701

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

26.0

m344
State has adopted or implemented the Nurse Licensure Compact (NLC).
Measure Name

M344

Measure Source

National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States

Data date(s)

2014-2020

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.

Score

Yes

m338
State requires health care facilities to report health care associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems.
Measure Name

M338

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report

Data date(s)

2012 & 2013

Limitations

The measure does not evaluate the health care facility compliance with reporting requirements.

Score

Foundational

m341
State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department.
Measure Name

M341

Measure Source

CDC Public Health Law Program resources. https://www.cdc.gov/phlp/

Data date(s)

2013

Limitations

The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.

Score

Foundational

m342
State law requires health care facilities to report communicable diseases to a health department.
Measure Name

M342

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013

Limitations

The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.

Score

Foundational

m345
State has adopted Emergency Management Assistance Compact (EMAC) legislation.
Measure Name

M345

Measure Source

National Emergency Management Association (NEMA)

Data date(s)

2014

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.

Score

Foundational

The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.

6.4
Measure
Measure Description
Score
m64
State has a public information and communication plan developed for a mass prophylaxis campaign.
Measure Name

M64

Measure Source

Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.

Data date(s)

2012-2018

Limitations

The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.

Score

Foundational

m228
Percent of households in the state with broadband in the home.
Measure Name

M228

Measure Source

American Community Survey (ACS), 1-year estimate (GCT2801).

Data date(s)

2012-2019

Limitations

The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.

Score

72.5%

m906
Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
Measure Name

M906

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

89.0%

m907
Percent of office-based medical doctors and doctors of osteopathy in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs.
Measure Name

M907

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

40.0%

m1001
The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure.
Measure Name

M1001

Measure Source

National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).

Data date(s)

2014-2019

Limitations

Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.

Score

Yes

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Health Care Delivery

pc: prehospital care

hps: hospital and physician services

ltc: long term care

mbh: mental behavioral health care

hc: home care

This is best viewed on desktop.

Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.

4.7
Measure
Measure Description
Score
m140
Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state.
Measure Name

M140

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

52.6

m331
Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state.
Measure Name

M331

Measure Source

National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information

Data date(s)

2015 & 2019

Limitations

The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.

Score

93.7%

m349
State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation.
Measure Name

M349

Measure Source

National Association of State EMS Officials

Data date(s)

2013-2018, 2020-2021

Limitations

Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.

Score

No

m350u
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas.
Measure Name

M350U

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

7.9

m350r
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas.
Measure Name

M350R

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

12.6

Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.

5.3
Measure
Measure Description
Score
m147
Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1).
Measure Name

M147

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2019

Limitations

The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.

Score

283.0

m148
Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2).
Measure Name

M148

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2020

Limitations

The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.

Score

97.0

m152
Percent of the state's population who live within 50 miles of a trauma center, including out-of-state centers.
Measure Name

M152

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.

Score

99.6%

m160
Number of physicians per 100,000 population in the state.
Measure Name

M160

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2011-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.

Score

82.9

m167
Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state.
Measure Name

M167

Measure Source

National Council of State Boards of Nursing (NCSBN), National Nursing Database

Data date(s)

2013-2016, 2018-2021

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.

Score

1,579.7

m168
Percent of the state's population living within 100 miles of a burn center, including out-of-state centers.
Measure Name

M168

Measure Source

American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.

Data date(s)

2014 & 2018

Limitations

The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.

Score

98.0%

m296
Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care).
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.

Score

36.1%

m297
Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program).
Measure Name

M297

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.

Score

32.0%

m298
Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states.
Measure Name

M298

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.

Score

38.8

m299
Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia.
Measure Name

M299

Measure Source

The Commonwealth Fund, Scorecard on State Health System Performance

Data date(s)

2011-2018

Limitations

Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.

Score

13.1%

m300
Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score.
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013-2020

Limitations

The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.

Score

52.0%

Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.

4.6
Measure
Measure Description
Score
m308
Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M308

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

0.8

m309
Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state.
Measure Name

M309

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

2.4

m307
Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine.
Measure Name

M307

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2013-2021

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

92.5%

m310
Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M310

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

1.1

m303b
Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (expressed as quintiles).
Measure Name

M303B

Measure Source

CMS Nursing Facility Inspection Reports

Data date(s)

2014-2020

Limitations

Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.

Score

4.0

m23nh
Number of disease outbreaks in nursing homes or assisted living facilities with a confirmed etiological agent (per 10,000 certified nursing home residents)
Measure Name

M23NH

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

States vary in their ability to detect and report outbreaks in long-term care settings.

Score

20.8

m880
Percentage of nursing home residents at facilities that did not have an infection control deficiency.
Measure Name

M880

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies

Data date(s)

2017-2020

Limitations

Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.

Score

49.2%

Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.

5.9
Measure
Measure Description
Score
m316
Percent of hospitals in the state providing psychiatric emergency services.
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.

Score

34.4%

m317
Percent of need met for mental health care in health professional shortage areas (HPSA) in the state.
Measure Name

M317

Measure Source

The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services

Data date(s)

2014, 2016-2020

Limitations

The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.

Score

61.0%

m800
Percent of the state's population not living in an HRSA Mental Health Professional Shortage Area.
Measure Name

M800

Measure Source

U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.

Data date(s)

2015-2020

Limitations

The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.

Score

71.1%

Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.

4.8
Measure
Measure Description
Score
m291
Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season.
Measure Name

M291

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

73.0%

m292
Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner.
Measure Name

M292

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality of the services provided including length of service delays.

Score

91.0%

m293
Number of home health and personal care aides per 1,000 population in the state aged 65 or older.
Measure Name

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)

Data date(s)

2012-2019

Limitations

The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.

Score

30.0

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Countermeasure Management

mmmdd: medical materiel management distribution dispensing

cue: countermeasure utilization effectiveness

This is best viewed on desktop.

The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.

4.3
Measure
Measure Description
Score
m60
State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements.
Measure Name

M60

Measure Source

CDC PHEP

Data date(s)

2012-2018

Limitations

The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.

Score

Foundational

m161
Number of Pharmacists per 100,000 population in the state.
Measure Name

M161

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

89.0

m270
Percent of hospitals in the state participating in a group purchasing arrangement.
Measure Name

M270

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.

Score

55.7%

The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.

5.2
Measure
Measure Description
Score
m24
Percent of children ages 19-35 months in the state receiving the recommended routine childhood combined 7-vaccine series (4:3:1:3*:3:1:4), which includes ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, the full series of Hib (≥3 or ≥4 doses, depending on product type), ≥3 doses of HepB, ≥1 dose of varicella vaccine, and ≥4 doses of PCV.
Measure Name

M24

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)

Data date(s)

2012-2019

Limitations

The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.

Score

69.8%

m32
Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination.
Measure Name

M32

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

69.7%

m33
Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination.
Measure Name

M33

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel.

Data date(s)

2012-2019

Limitations

The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.

Score

65.7%

m34
Percent of children aged 6 months to 4 years old in the state receiving a seasonal flu vaccination.
Measure Name

M34

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2012-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

72.2%

m35
Percent of adults aged 18 years and older in the state receiving a seasonal flu vaccination.
Measure Name

M35

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

46.0%

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Environmental & Occupational Health

fws: food water security

em: environmental monitoring

pei: physical environment and infrastructure

wr: workforce resiliency

This is best viewed on desktop.

The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.

9.3
Measure
Measure Description
Score
m275_dw
State public health laboratory provides or assures testing for drinking water.
Measure Name

M275_DW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

Yes

m275_pww
State public health laboratory provides or assures testing for private well water.
Measure Name

M275_PWW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_rec
State public health laboratory provides or assures testing for recreational water.
Measure Name

M275_REC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_sur
State public health laboratory provides or assures testing for surface water.
Measure Name

M275_SUR

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m275_wst
State public health laboratory provides or assu+M132res testing for waste water.
Measure Name

M275_WST

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m276
Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.
Measure Name

M276

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

100.0%

m195
Percentage of community water systems in a state that meet all applicable health-based standards.
Measure Name

M195

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

92.7%

m925
Percentage of community water systems in a state that meet all applicable non-health-based standards.
Measure Name

M925

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

81.0%

m23pc
Estimated total number of foodborne individual illness cases reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population).
Measure Name

M23PC

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

25.4

The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.

7.9
Measure
Measure Description
Score
m202
State public health laboratory provides or assures testing for air samples.
Measure Name

M202

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m257_aiha
State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA).
Measure Name

M257_AIHA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

No

m257_epa
State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA).
Measure Name

M257_EPA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m257_nelac
State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC).
Measure Name

M257_NELAC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m196
State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism.
Measure Name

M196

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Foundational

m272
Percent of 10 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds.
Measure Name

M272

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

90.0%

m273
State public health laboratory provides or assures testing for hazardous waste.
Measure Name

M273

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m274
State participates in the National Plant Diagnostic Network (NPDN).
Measure Name

M274

Measure Source

National Plant Diagnostic Network (NPDN), National Plant Diagnostic website

Data date(s)

2014

Limitations

The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.

Score

Foundational

m904
Number of environmental scientists and specialists (including health) per 100,000 population in the state.
Measure Name

M904

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041

Data date(s)

2012-2019

Limitations

The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

38.5

m23a
Number of disease outbreaks due to animal contact in a state where the etiological agent is confirm (per 1 million population).
Measure Name

M23A

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.

Score

0.1

Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.

6.7
Measure
Measure Description
Score
m922
Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor).
Measure Name

M922

Measure Source

U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures

Data date(s)

2012-2019

Limitations

The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.

Score

91.6%

m923
Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition.
Measure Name

M923

Measure Source

U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)

Data date(s)

2016, 2018 & 2019

Limitations

A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type.  Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states

Score

63.7%

m928
Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program.
Measure Name

M928

Measure Source

FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)

Data date(s)

2017-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP. 

Score

48.5%

m929
Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains.
Measure Name

M929

Measure Source

U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)

Data date(s)

2013-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP.  Also, many flood zone maps are outdated.

Score

53.5%

m334
State has a climate change adaptation plan.
Measure Name

M334

Measure Source

Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation

Data date(s)

2014-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.

Score

Yes

Actions taken to protect workers and emergency responders from health hazards while on the job.

3.9
Measure
Measure Description
Score
m530
Percent of employed workers in the state who used some type of paid time off (PTO) benefit.
Measure Name

M530

Measure Source

Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.

Data date(s)

2013-2020

Limitations

Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.

Score

58.3%

m531
Percent of employed population in the state engaging in some work from home by telecommuting.
Measure Name

M531

Measure Source

Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.

Data date(s)

2011-2013, 2015, 2017, 2019

Limitations

The measure data is estimated based on a survey of a sample of the general population.

Score

9.5%

m705
Percent of employed population (16 and older) in the state who work from home.
Measure Name

M705

Measure Source

American Community Survey (ACS), 1-year estimate (Table B08128)

Data date(s)

2012-2019

Limitations

The measure data does not include all individuals who can work at home on a "part-time" basis.

Score

4.7%

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Health Security Surveillance

phsei: health surveillance epidemiological investigation

bmlt: biological monitoring laboratory testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.

6.7
Measure
Measure Description
Score
m17
State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS).
Measure Name

M17

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.

Data date(s)

2012-2015

Limitations

The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.

Score

Foundational

m18
Number of epidemiologists per 100,000 population in the state, by quintile.
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction

Data date(s)

2012-2019

Limitations

The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

1.0

m19
State health department participates in the Epidemic Information Exchange (Epi-X) System.
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m20
State health department participates in the National Electronic Disease Surveillance System (NEDSS).
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013-2015

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m22
State health department has a syndromic surveillance system that can report and exchange information.
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012, 2016, & 2019

Limitations

Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.

Score

Yes

m217
State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies.
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m220
State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory.
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m256
State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet).
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

m23
Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed.
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

64.3%

m289
State health department participates in a broad prevention collaborative addressing health care associated infections (HAIs).
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.

Score

Foundational

m290
State has a public health veterinarian.
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015, 2017-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.

Score

Yes

m265
State uses an Electronic Death Registration System (EDRS).
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014-2018, 2020-2021

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.

Score

No

m801
State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network.
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.

8.2
Measure
Measure Description
Score
m1
Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise.
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2013

Limitations

The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.

Score

Foundational

m1314
State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA).
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results

Score

No

m208
State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service).
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m8
State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1).
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

No

m9
State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines.
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m11
State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours.
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m12
State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory.
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.

Score

Yes

m211
Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella.
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

100.0%

m216
Percent of 15 to 21 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin-mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies. The 2018 CLSS survey added 6 more items (i.e., Ebola, Chikungunya, Zika, Lyme disease, Candida auris, and Mobilized colistin resistance (MCR 1)), increasing the total to 21 tests.
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

93.3%

m2
Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories.
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Laboratories may not undergo proficiency testing for all assay capabilities.

Score

100.0%

m3
Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.

Score

100.0%

m5
Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state's Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise.
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2013-2017

Limitations

The measure does not consider the public health laboratory's ability to process a large number of samples.

Score

100.0%

m7
Number of additional chemical agent detection methods-beyond the core methods-demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state.
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider all methods that the laboratory is capable of testing.

Score

4.0

m286
Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually.
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

4.0

m287
Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.

Score

100.0%

m288
Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state.
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.

Score

9.0

m911
State public health laboratory provides or assures testing for soil.
Measure Name

M911

Measure Source

Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m902
State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory).
Measure Name

M902

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)

Data date(s)

2016 & 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.

Score

Yes

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Community Planning & Engagement Coordination

cscc: cross sector community collaboration

arp: children other at risk populations

mvde: management of volunteers during emergencies

scc: social capital cohesion

This is best viewed on desktop.

The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.

3.0
Measure
Measure Description
Score
m87
State health department is accredited by the Public Health Accreditation Board (PHAB).
Measure Name

M87

Measure Source

Public Health Accreditation Board (PHAB), Health Departments in e-PHAB

Data date(s)

2013-2020

Limitations

The measure does not reflect health departments that are in process of achieving accreditation.

Score

No

m501
Percent of the state's population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems.
Measure Name

M501

Measure Source

National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.

Data date(s)

2012, 2014, 2016 & 2018

Limitations

Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.

Score

36.0%

m9031
Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9031

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

m9032
Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9032

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

1.6%

m9033
Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9033

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

7.9%

m9034
Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9034

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

28.6%

Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.

6.2
Measure
Measure Description
Score
m163
Number of pediatricians per 100,000 population under 18 years old in the state.
Measure Name

M163

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.

Score

80.2

m164
Number of obstetricians and gynecologists per 100,000 female population in the state.
Measure Name

M164

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.

Score

25.1

m170
Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers.
Measure Name

M170

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.

Score

96.6%

m53b
Percent of youth who missed one or more days of school in past month due to concerns about safety.
Measure Name

M53B

Measure Source

Youth Risk Behavior Survey

Data date(s)

2011, 2013, 2015, 2017 & 2019

Limitations

The measure is self-reported and does not distinguish reasons for safety concerns.

Score

5.5%

The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.

3.9
Measure
Measure Description
Score
m36
State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry.
Measure Name

M36

Measure Source

Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Data date(s)

2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.

Score

Foundational

m266
Percent of the state's population who live in a county with a Community Emergency Response Teams (CERT).
Measure Name

M266

Measure Source

Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016

Limitations

The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.

Score

66.2%

m346
Number of total Medical Reserve Corps members per 100,000 population in the state.
Measure Name

M346

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).

Score

157.9

m176
Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state.
Measure Name

M176

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.

Score

5.5

m179
Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state.
Measure Name

M179

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.

Score

46.1

m186
Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state.
Measure Name

M186

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.

Score

106.3

The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.

2.9
Measure
Measure Description
Score
m175
Percent of voting-eligible population in the state participating in the highest office election .
Measure Name

M175

Measure Source

United States Election Project, General Election Turnout Rates

Data date(s)

2012, 2014, 2016, 2018 & 2020

Limitations

The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).

Score

36.6%

m188
Percent of adults in the state who volunteer in their communities
Measure Name

M188

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.

Score

30.4%

m189
Number of annual volunteer hours per state resident, 15 years and older.
Measure Name

M189

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.

Score

37.5

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Incident & Information Management

incm: incident management

infm: information management

This is best viewed on desktop.

The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.

9.9
Measure
Measure Description
Score
m10
State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners.
Measure Name

M10

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2016

Limitations

The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.

Score

Foundational

m84
State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP).
Measure Name

M84

Measure Source

Emergency Management Accreditation Program (EMAP), Who Is Accredited?

Data date(s)

2014-2020

Limitations

The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.

Score

Yes

m107
Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii.
Measure Name

M107

Measure Source

National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments

Data date(s)

2013 & 2016

Limitations

The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.

Score

100.0%

m229
State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency.
Measure Name

M229

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.

Score

Foundational

m150
State uses a system for tracking hospital bed availability during emergencies.
Measure Name

M150

Measure Source

Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program

Data date(s)

2012-2018

Limitations

The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.

Score

Foundational

m701
Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty.
Measure Name

M701

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

28.0

m344
State has adopted or implemented the Nurse Licensure Compact (NLC).
Measure Name

M344

Measure Source

National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States

Data date(s)

2014-2020

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.

Score

Yes

m338
State requires health care facilities to report health care associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems.
Measure Name

M338

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report

Data date(s)

2012 & 2013

Limitations

The measure does not evaluate the health care facility compliance with reporting requirements.

Score

Foundational

m341
State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department.
Measure Name

M341

Measure Source

CDC Public Health Law Program resources. https://www.cdc.gov/phlp/

Data date(s)

2013

Limitations

The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.

Score

Foundational

m342
State law requires health care facilities to report communicable diseases to a health department.
Measure Name

M342

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013

Limitations

The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.

Score

Foundational

m345
State has adopted Emergency Management Assistance Compact (EMAC) legislation.
Measure Name

M345

Measure Source

National Emergency Management Association (NEMA)

Data date(s)

2014

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.

Score

Foundational

The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.

7.1
Measure
Measure Description
Score
m64
State has a public information and communication plan developed for a mass prophylaxis campaign.
Measure Name

M64

Measure Source

Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.

Data date(s)

2012-2018

Limitations

The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.

Score

Foundational

m228
Percent of households in the state with broadband in the home.
Measure Name

M228

Measure Source

American Community Survey (ACS), 1-year estimate (GCT2801).

Data date(s)

2012-2019

Limitations

The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.

Score

75.8%

m906
Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
Measure Name

M906

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

91.0%

m907
Percent of office-based medical doctors and doctors of osteopathy in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs.
Measure Name

M907

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

52.0%

m1001
The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure.
Measure Name

M1001

Measure Source

National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).

Data date(s)

2014-2019

Limitations

Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.

Score

Yes

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Health Care Delivery

pc: prehospital care

hps: hospital and physician services

ltc: long term care

mbh: mental behavioral health care

hc: home care

This is best viewed on desktop.

Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.

4.8
Measure
Measure Description
Score
m140
Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state.
Measure Name

M140

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

56.0

m331
Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state.
Measure Name

M331

Measure Source

National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information

Data date(s)

2015 & 2019

Limitations

The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.

Score

93.7%

m349
State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation.
Measure Name

M349

Measure Source

National Association of State EMS Officials

Data date(s)

2013-2018, 2020-2021

Limitations

Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.

Score

No

m350u
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas.
Measure Name

M350U

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

7.9

m350r
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas.
Measure Name

M350R

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

12.6

Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.

5.3
Measure
Measure Description
Score
m147
Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1).
Measure Name

M147

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2019

Limitations

The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.

Score

272.0

m148
Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2).
Measure Name

M148

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2020

Limitations

The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.

Score

93.0

m152
Percent of the state's population who live within 50 miles of a trauma center, including out-of-state centers.
Measure Name

M152

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.

Score

99.6%

m160
Number of physicians per 100,000 population in the state.
Measure Name

M160

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2011-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.

Score

83.1

m167
Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state.
Measure Name

M167

Measure Source

National Council of State Boards of Nursing (NCSBN), National Nursing Database

Data date(s)

2013-2016, 2018-2021

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.

Score

1,532.9

m168
Percent of the state's population living within 100 miles of a burn center, including out-of-state centers.
Measure Name

M168

Measure Source

American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.

Data date(s)

2014 & 2018

Limitations

The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.

Score

98.0%

m296
Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care).
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.

Score

36.6%

m297
Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program).
Measure Name

M297

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.

Score

31.7%

m298
Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states.
Measure Name

M298

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.

Score

41.8

m299
Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia.
Measure Name

M299

Measure Source

The Commonwealth Fund, Scorecard on State Health System Performance

Data date(s)

2011-2018

Limitations

Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.

Score

13.3%

m300
Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score.
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013-2020

Limitations

The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.

Score

48.4%

Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.

4.3
Measure
Measure Description
Score
m308
Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M308

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

0.8

m309
Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state.
Measure Name

M309

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

2.4

m307
Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine.
Measure Name

M307

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2013-2021

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

90.9%

m310
Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M310

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

1.1

m303b
Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (expressed as quintiles).
Measure Name

M303B

Measure Source

CMS Nursing Facility Inspection Reports

Data date(s)

2014-2020

Limitations

Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.

Score

4.0

m23nh
Number of disease outbreaks in nursing homes or assisted living facilities with a confirmed etiological agent (per 10,000 certified nursing home residents)
Measure Name

M23NH

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

States vary in their ability to detect and report outbreaks in long-term care settings.

Score

24.2

m880
Percentage of nursing home residents at facilities that did not have an infection control deficiency.
Measure Name

M880

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies

Data date(s)

2017-2020

Limitations

Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.

Score

49.2%

Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.

5.8
Measure
Measure Description
Score
m316
Percent of hospitals in the state providing psychiatric emergency services.
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.

Score

32.5%

m317
Percent of need met for mental health care in health professional shortage areas (HPSA) in the state.
Measure Name

M317

Measure Source

The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services

Data date(s)

2014, 2016-2020

Limitations

The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.

Score

61.0%

m800
Percent of the state's population not living in an HRSA Mental Health Professional Shortage Area.
Measure Name

M800

Measure Source

U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.

Data date(s)

2015-2020

Limitations

The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.

Score

71.1%

Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.

5.3
Measure
Measure Description
Score
m291
Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season.
Measure Name

M291

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

75.0%

m292
Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner.
Measure Name

M292

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality of the services provided including length of service delays.

Score

92.0%

m293
Number of home health and personal care aides per 1,000 population in the state aged 65 or older.
Measure Name

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)

Data date(s)

2012-2019

Limitations

The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.

Score

31.6

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Countermeasure Management

mmmdd: medical materiel management distribution dispensing

cue: countermeasure utilization effectiveness

This is best viewed on desktop.

The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.

4.3
Measure
Measure Description
Score
m60
State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements.
Measure Name

M60

Measure Source

CDC PHEP

Data date(s)

2012-2018

Limitations

The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.

Score

Foundational

m161
Number of Pharmacists per 100,000 population in the state.
Measure Name

M161

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

89.7

m270
Percent of hospitals in the state participating in a group purchasing arrangement.
Measure Name

M270

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.

Score

56.1%

The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.

5.6
Measure
Measure Description
Score
m24
Percent of children ages 19-35 months in the state receiving the recommended routine childhood combined 7-vaccine series (4:3:1:3*:3:1:4), which includes ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, the full series of Hib (≥3 or ≥4 doses, depending on product type), ≥3 doses of HepB, ≥1 dose of varicella vaccine, and ≥4 doses of PCV.
Measure Name

M24

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)

Data date(s)

2012-2019

Limitations

The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.

Score

69.2%

m32
Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination.
Measure Name

M32

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

69.1%

m33
Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination.
Measure Name

M33

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel.

Data date(s)

2012-2019

Limitations

The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.

Score

71.0%

m34
Percent of children aged 6 months to 4 years old in the state receiving a seasonal flu vaccination.
Measure Name

M34

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2012-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

72.3%

m35
Percent of adults aged 18 years and older in the state receiving a seasonal flu vaccination.
Measure Name

M35

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

47.2%

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Environmental & Occupational Health

fws: food water security

em: environmental monitoring

pei: physical environment and infrastructure

wr: workforce resiliency

This is best viewed on desktop.

The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.

9.4
Measure
Measure Description
Score
m275_dw
State public health laboratory provides or assures testing for drinking water.
Measure Name

M275_DW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

Yes

m275_pww
State public health laboratory provides or assures testing for private well water.
Measure Name

M275_PWW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_rec
State public health laboratory provides or assures testing for recreational water.
Measure Name

M275_REC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_sur
State public health laboratory provides or assures testing for surface water.
Measure Name

M275_SUR

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m275_wst
State public health laboratory provides or assu+M132res testing for waste water.
Measure Name

M275_WST

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m276
Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.
Measure Name

M276

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

100.0%

m195
Percentage of community water systems in a state that meet all applicable health-based standards.
Measure Name

M195

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

92.0%

m925
Percentage of community water systems in a state that meet all applicable non-health-based standards.
Measure Name

M925

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

86.5%

m23pc
Estimated total number of foodborne individual illness cases reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population).
Measure Name

M23PC

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

23.7

The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.

7.9
Measure
Measure Description
Score
m202
State public health laboratory provides or assures testing for air samples.
Measure Name

M202

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m257_aiha
State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA).
Measure Name

M257_AIHA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

No

m257_epa
State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA).
Measure Name

M257_EPA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m257_nelac
State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC).
Measure Name

M257_NELAC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m196
State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism.
Measure Name

M196

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Foundational

m272
Percent of 10 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds.
Measure Name

M272

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

90.0%

m273
State public health laboratory provides or assures testing for hazardous waste.
Measure Name

M273

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m274
State participates in the National Plant Diagnostic Network (NPDN).
Measure Name

M274

Measure Source

National Plant Diagnostic Network (NPDN), National Plant Diagnostic website

Data date(s)

2014

Limitations

The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.

Score

Foundational

m904
Number of environmental scientists and specialists (including health) per 100,000 population in the state.
Measure Name

M904

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041

Data date(s)

2012-2019

Limitations

The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

39.9

m23a
Number of disease outbreaks due to animal contact in a state where the etiological agent is confirm (per 1 million population).
Measure Name

M23A

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.

Score

0.1

Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.

6.7
Measure
Measure Description
Score
m922
Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor).
Measure Name

M922

Measure Source

U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures

Data date(s)

2012-2019

Limitations

The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.

Score

92.2%

m923
Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition.
Measure Name

M923

Measure Source

U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)

Data date(s)

2016, 2018 & 2019

Limitations

A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type.  Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states

Score

63.7%

m928
Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program.
Measure Name

M928

Measure Source

FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)

Data date(s)

2017-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP. 

Score

48.5%

m929
Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains.
Measure Name

M929

Measure Source

U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)

Data date(s)

2013-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP.  Also, many flood zone maps are outdated.

Score

51.9%

m334
State has a climate change adaptation plan.
Measure Name

M334

Measure Source

Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation

Data date(s)

2014-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.

Score

Yes

Actions taken to protect workers and emergency responders from health hazards while on the job.

3.8
Measure
Measure Description
Score
m530
Percent of employed workers in the state who used some type of paid time off (PTO) benefit.
Measure Name

M530

Measure Source

Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.

Data date(s)

2013-2020

Limitations

Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.

Score

58.6%

m531
Percent of employed population in the state engaging in some work from home by telecommuting.
Measure Name

M531

Measure Source

Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.

Data date(s)

2011-2013, 2015, 2017, 2019

Limitations

The measure data is estimated based on a survey of a sample of the general population.

Score

7.9%

m705
Percent of employed population (16 and older) in the state who work from home.
Measure Name

M705

Measure Source

American Community Survey (ACS), 1-year estimate (Table B08128)

Data date(s)

2012-2019

Limitations

The measure data does not include all individuals who can work at home on a "part-time" basis.

Score

4.5%

Close Window

Health Security Surveillance

phsei: health surveillance epidemiological investigation

bmlt: biological monitoring laboratory testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.

8.0
Measure
Measure Description
Score
m17
State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS).
Measure Name

M17

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.

Data date(s)

2012-2015

Limitations

The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.

Score

Foundational

m18
Number of epidemiologists per 100,000 population in the state, by quintile.
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction

Data date(s)

2012-2019

Limitations

The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

1.0

m19
State health department participates in the Epidemic Information Exchange (Epi-X) System.
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m20
State health department participates in the National Electronic Disease Surveillance System (NEDSS).
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013-2015

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m22
State health department has a syndromic surveillance system that can report and exchange information.
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012, 2016, & 2019

Limitations

Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.

Score

Yes

m217
State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies.
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m220
State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory.
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m256
State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet).
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

m23
Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed.
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

54.6%

m289
State health department participates in a broad prevention collaborative addressing health care associated infections (HAIs).
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.

Score

Foundational

m290
State has a public health veterinarian.
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015, 2017-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.

Score

Yes

m265
State uses an Electronic Death Registration System (EDRS).
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014-2018, 2020-2021

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.

Score

Yes

m801
State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network.
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.

8.2
Measure
Measure Description
Score
m1
Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise.
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2013

Limitations

The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.

Score

Foundational

m1314
State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA).
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results

Score

No

m208
State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service).
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m8
State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1).
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

No

m9
State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines.
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m11
State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours.
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m12
State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory.
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.

Score

Yes

m211
Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella.
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

100.0%

m216
Percent of 15 to 21 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin-mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies. The 2018 CLSS survey added 6 more items (i.e., Ebola, Chikungunya, Zika, Lyme disease, Candida auris, and Mobilized colistin resistance (MCR 1)), increasing the total to 21 tests.
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

93.3%

m2
Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories.
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Laboratories may not undergo proficiency testing for all assay capabilities.

Score

100.0%

m3
Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.

Score

98.0%

m5
Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state's Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise.
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2013-2017

Limitations

The measure does not consider the public health laboratory's ability to process a large number of samples.

Score

100.0%

m7
Number of additional chemical agent detection methods-beyond the core methods-demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state.
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider all methods that the laboratory is capable of testing.

Score

4.0

m286
Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually.
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

4.0

m287
Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.

Score

100.0%

m288
Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state.
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.

Score

9.0

m911
State public health laboratory provides or assures testing for soil.
Measure Name

M911

Measure Source

Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m902
State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory).
Measure Name

M902

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)

Data date(s)

2016 & 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.

Score

Yes

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Community Planning & Engagement Coordination

cscc: cross sector community collaboration

arp: children other at risk populations

mvde: management of volunteers during emergencies

scc: social capital cohesion

This is best viewed on desktop.

The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.

3.2
Measure
Measure Description
Score
m87
State health department is accredited by the Public Health Accreditation Board (PHAB).
Measure Name

M87

Measure Source

Public Health Accreditation Board (PHAB), Health Departments in e-PHAB

Data date(s)

2013-2020

Limitations

The measure does not reflect health departments that are in process of achieving accreditation.

Score

No

m501
Percent of the state's population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems.
Measure Name

M501

Measure Source

National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.

Data date(s)

2012, 2014, 2016 & 2018

Limitations

Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.

Score

36.0%

m9031
Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9031

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

m9032
Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9032

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

13.4%

m9033
Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9033

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

10.1%

m9034
Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9034

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

29.4%

Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.

6.3
Measure
Measure Description
Score
m163
Number of pediatricians per 100,000 population under 18 years old in the state.
Measure Name

M163

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.

Score

83.8

m164
Number of obstetricians and gynecologists per 100,000 female population in the state.
Measure Name

M164

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.

Score

25.0

m170
Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers.
Measure Name

M170

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.

Score

96.4%

m53b
Percent of youth who missed one or more days of school in past month due to concerns about safety.
Measure Name

M53B

Measure Source

Youth Risk Behavior Survey

Data date(s)

2011, 2013, 2015, 2017 & 2019

Limitations

The measure is self-reported and does not distinguish reasons for safety concerns.

Score

5.4%

The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.

3.9
Measure
Measure Description
Score
m36
State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry.
Measure Name

M36

Measure Source

Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Data date(s)

2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.

Score

Foundational

m266
Percent of the state's population who live in a county with a Community Emergency Response Teams (CERT).
Measure Name

M266

Measure Source

Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016

Limitations

The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.

Score

66.1%

m346
Number of total Medical Reserve Corps members per 100,000 population in the state.
Measure Name

M346

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).

Score

157.9

m176
Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state.
Measure Name

M176

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.

Score

5.5

m179
Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state.
Measure Name

M179

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.

Score

46.1

m186
Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state.
Measure Name

M186

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.

Score

106.3

The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.

3.4
Measure
Measure Description
Score
m175
Percent of voting-eligible population in the state participating in the highest office election .
Measure Name

M175

Measure Source

United States Election Project, General Election Turnout Rates

Data date(s)

2012, 2014, 2016, 2018 & 2020

Limitations

The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).

Score

36.6%

m188
Percent of adults in the state who volunteer in their communities
Measure Name

M188

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.

Score

31.4%

m189
Number of annual volunteer hours per state resident, 15 years and older.
Measure Name

M189

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.

Score

46.2

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Incident & Information Management

incm: incident management

infm: information management

This is best viewed on desktop.

The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.

9.9
Measure
Measure Description
Score
m10
State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners.
Measure Name

M10

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2016

Limitations

The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.

Score

Foundational

m84
State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP).
Measure Name

M84

Measure Source

Emergency Management Accreditation Program (EMAP), Who Is Accredited?

Data date(s)

2014-2020

Limitations

The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.

Score

Yes

m107
Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii.
Measure Name

M107

Measure Source

National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments

Data date(s)

2013 & 2016

Limitations

The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.

Score

100.0%

m229
State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency.
Measure Name

M229

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.

Score

Foundational

m150
State uses a system for tracking hospital bed availability during emergencies.
Measure Name

M150

Measure Source

Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program

Data date(s)

2012-2018

Limitations

The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.

Score

Foundational

m701
Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty.
Measure Name

M701

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

25.0

m344
State has adopted or implemented the Nurse Licensure Compact (NLC).
Measure Name

M344

Measure Source

National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States

Data date(s)

2014-2020

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.

Score

Yes

m338
State requires health care facilities to report health care associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems.
Measure Name

M338

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report

Data date(s)

2012 & 2013

Limitations

The measure does not evaluate the health care facility compliance with reporting requirements.

Score

Foundational

m341
State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department.
Measure Name

M341

Measure Source

CDC Public Health Law Program resources. https://www.cdc.gov/phlp/

Data date(s)

2013

Limitations

The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.

Score

Foundational

m342
State law requires health care facilities to report communicable diseases to a health department.
Measure Name

M342

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013

Limitations

The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.

Score

Foundational

m345
State has adopted Emergency Management Assistance Compact (EMAC) legislation.
Measure Name

M345

Measure Source

National Emergency Management Association (NEMA)

Data date(s)

2014

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.

Score

Foundational

The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.

7.5
Measure
Measure Description
Score
m64
State has a public information and communication plan developed for a mass prophylaxis campaign.
Measure Name

M64

Measure Source

Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.

Data date(s)

2012-2018

Limitations

The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.

Score

Foundational

m228
Percent of households in the state with broadband in the home.
Measure Name

M228

Measure Source

American Community Survey (ACS), 1-year estimate (GCT2801).

Data date(s)

2012-2019

Limitations

The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.

Score

77.2%

m906
Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
Measure Name

M906

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

92.0%

m907
Percent of office-based medical doctors and doctors of osteopathy in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs.
Measure Name

M907

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

58.0%

m1001
The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure.
Measure Name

M1001

Measure Source

National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).

Data date(s)

2014-2019

Limitations

Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.

Score

Yes

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Health Care Delivery

pc: prehospital care

hps: hospital and physician services

ltc: long term care

mbh: mental behavioral health care

hc: home care

This is best viewed on desktop.

Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.

7.1
Measure
Measure Description
Score
m140
Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state.
Measure Name

M140

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

61.1

m331
Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state.
Measure Name

M331

Measure Source

National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information

Data date(s)

2015 & 2019

Limitations

The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.

Score

93.7%

m349
State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation.
Measure Name

M349

Measure Source

National Association of State EMS Officials

Data date(s)

2013-2018, 2020-2021

Limitations

Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.

Score

Yes

m350u
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas.
Measure Name

M350U

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

7.9

m350r
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas.
Measure Name

M350R

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

12.6

Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.

5.4
Measure
Measure Description
Score
m147
Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1).
Measure Name

M147

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2019

Limitations

The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.

Score

274.0

m148
Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2).
Measure Name

M148

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2020

Limitations

The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.

Score

92.0

m152
Percent of the state's population who live within 50 miles of a trauma center, including out-of-state centers.
Measure Name

M152

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.

Score

99.2%

m160
Number of physicians per 100,000 population in the state.
Measure Name

M160

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2011-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.

Score

84.3

m167
Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state.
Measure Name

M167

Measure Source

National Council of State Boards of Nursing (NCSBN), National Nursing Database

Data date(s)

2013-2016, 2018-2021

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.

Score

1,557.9

m168
Percent of the state's population living within 100 miles of a burn center, including out-of-state centers.
Measure Name

M168

Measure Source

American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.

Data date(s)

2014 & 2018

Limitations

The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.

Score

98.0%

m296
Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care).
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.

Score

32.0%

m297
Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program).
Measure Name

M297

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.

Score

34.4%

m298
Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states.
Measure Name

M298

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.

Score

42.8

m299
Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia.
Measure Name

M299

Measure Source

The Commonwealth Fund, Scorecard on State Health System Performance

Data date(s)

2011-2018

Limitations

Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.

Score

13.5%

m300
Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score.
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013-2020

Limitations

The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.

Score

53.1%

Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.

4.2
Measure
Measure Description
Score
m308
Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M308

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

0.8

m309
Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state.
Measure Name

M309

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

2.3

m307
Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine.
Measure Name

M307

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2013-2021

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

89.4%

m310
Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M310

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

1.1

m303b
Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (expressed as quintiles).
Measure Name

M303B

Measure Source

CMS Nursing Facility Inspection Reports

Data date(s)

2014-2020

Limitations

Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.

Score

4.0

m23nh
Number of disease outbreaks in nursing homes or assisted living facilities with a confirmed etiological agent (per 10,000 certified nursing home residents)
Measure Name

M23NH

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

States vary in their ability to detect and report outbreaks in long-term care settings.

Score

19.7

m880
Percentage of nursing home residents at facilities that did not have an infection control deficiency.
Measure Name

M880

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies

Data date(s)

2017-2020

Limitations

Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.

Score

49.2%

Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.

5.7
Measure
Measure Description
Score
m316
Percent of hospitals in the state providing psychiatric emergency services.
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.

Score

31.2%

m317
Percent of need met for mental health care in health professional shortage areas (HPSA) in the state.
Measure Name

M317

Measure Source

The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services

Data date(s)

2014, 2016-2020

Limitations

The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.

Score

61.0%

m800
Percent of the state's population not living in an HRSA Mental Health Professional Shortage Area.
Measure Name

M800

Measure Source

U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.

Data date(s)

2015-2020

Limitations

The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.

Score

71.1%

Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.

5.3
Measure
Measure Description
Score
m291
Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season.
Measure Name

M291

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

74.4%

m292
Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner.
Measure Name

M292

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality of the services provided including length of service delays.

Score

92.0%

m293
Number of home health and personal care aides per 1,000 population in the state aged 65 or older.
Measure Name

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)

Data date(s)

2012-2019

Limitations

The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.

Score

34.3

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Countermeasure Management

mmmdd: medical materiel management distribution dispensing

cue: countermeasure utilization effectiveness

This is best viewed on desktop.

The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.

3.8
Measure
Measure Description
Score
m60
State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements.
Measure Name

M60

Measure Source

CDC PHEP

Data date(s)

2012-2018

Limitations

The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.

Score

Foundational

m161
Number of Pharmacists per 100,000 population in the state.
Measure Name

M161

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

84.4

m270
Percent of hospitals in the state participating in a group purchasing arrangement.
Measure Name

M270

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.

Score

50.4%

The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.

6.0
Measure
Measure Description
Score
m24
Percent of children ages 19-35 months in the state receiving the recommended routine childhood combined 7-vaccine series (4:3:1:3*:3:1:4), which includes ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, the full series of Hib (≥3 or ≥4 doses, depending on product type), ≥3 doses of HepB, ≥1 dose of varicella vaccine, and ≥4 doses of PCV.
Measure Name

M24

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)

Data date(s)

2012-2019

Limitations

The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.

Score

73.7%

m32
Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination.
Measure Name

M32

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

67.7%

m33
Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination.
Measure Name

M33

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel.

Data date(s)

2012-2019

Limitations

The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.

Score

70.7%

m34
Percent of children aged 6 months to 4 years old in the state receiving a seasonal flu vaccination.
Measure Name

M34

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2012-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

73.9%

m35
Percent of adults aged 18 years and older in the state receiving a seasonal flu vaccination.
Measure Name

M35

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

48.2%

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Environmental & Occupational Health

fws: food water security

em: environmental monitoring

pei: physical environment and infrastructure

wr: workforce resiliency

This is best viewed on desktop.

The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.

9.4
Measure
Measure Description
Score
m275_dw
State public health laboratory provides or assures testing for drinking water.
Measure Name

M275_DW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

Yes

m275_pww
State public health laboratory provides or assures testing for private well water.
Measure Name

M275_PWW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_rec
State public health laboratory provides or assures testing for recreational water.
Measure Name

M275_REC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_sur
State public health laboratory provides or assures testing for surface water.
Measure Name

M275_SUR

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m275_wst
State public health laboratory provides or assu+M132res testing for waste water.
Measure Name

M275_WST

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m276
Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.
Measure Name

M276

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

100.0%

m195
Percentage of community water systems in a state that meet all applicable health-based standards.
Measure Name

M195

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

93.9%

m925
Percentage of community water systems in a state that meet all applicable non-health-based standards.
Measure Name

M925

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

84.9%

m23pc
Estimated total number of foodborne individual illness cases reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population).
Measure Name

M23PC

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

49.8

The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.

8.0
Measure
Measure Description
Score
m202
State public health laboratory provides or assures testing for air samples.
Measure Name

M202

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m257_aiha
State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA).
Measure Name

M257_AIHA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

No

m257_epa
State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA).
Measure Name

M257_EPA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m257_nelac
State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC).
Measure Name

M257_NELAC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m196
State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism.
Measure Name

M196

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Foundational

m272
Percent of 10 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds.
Measure Name

M272

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

90.0%

m273
State public health laboratory provides or assures testing for hazardous waste.
Measure Name

M273

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m274
State participates in the National Plant Diagnostic Network (NPDN).
Measure Name

M274

Measure Source

National Plant Diagnostic Network (NPDN), National Plant Diagnostic website

Data date(s)

2014

Limitations

The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.

Score

Foundational

m904
Number of environmental scientists and specialists (including health) per 100,000 population in the state.
Measure Name

M904

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041

Data date(s)

2012-2019

Limitations

The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

37.3

m23a
Number of disease outbreaks due to animal contact in a state where the etiological agent is confirm (per 1 million population).
Measure Name

M23A

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.

Score

0.0

Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.

6.7
Measure
Measure Description
Score
m922
Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor).
Measure Name

M922

Measure Source

U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures

Data date(s)

2012-2019

Limitations

The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.

Score

92.5%

m923
Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition.
Measure Name

M923

Measure Source

U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)

Data date(s)

2016, 2018 & 2019

Limitations

A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type.  Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states

Score

63.7%

m928
Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program.
Measure Name

M928

Measure Source

FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)

Data date(s)

2017-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP. 

Score

48.5%

m929
Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains.
Measure Name

M929

Measure Source

U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)

Data date(s)

2013-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP.  Also, many flood zone maps are outdated.

Score

49.6%

m334
State has a climate change adaptation plan.
Measure Name

M334

Measure Source

Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation

Data date(s)

2014-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.

Score

Yes

Actions taken to protect workers and emergency responders from health hazards while on the job.

4.3
Measure
Measure Description
Score
m530
Percent of employed workers in the state who used some type of paid time off (PTO) benefit.
Measure Name

M530

Measure Source

Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.

Data date(s)

2013-2020

Limitations

Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.

Score

58.8%

m531
Percent of employed population in the state engaging in some work from home by telecommuting.
Measure Name

M531

Measure Source

Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.

Data date(s)

2011-2013, 2015, 2017, 2019

Limitations

The measure data is estimated based on a survey of a sample of the general population.

Score

17.9%

m705
Percent of employed population (16 and older) in the state who work from home.
Measure Name

M705

Measure Source

American Community Survey (ACS), 1-year estimate (Table B08128)

Data date(s)

2012-2019

Limitations

The measure data does not include all individuals who can work at home on a "part-time" basis.

Score

4.4%

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Health Security Surveillance

phsei: health surveillance epidemiological investigation

bmlt: biological monitoring laboratory testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.

6.6
Measure
Measure Description
Score
m17
State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS).
Measure Name

M17

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.

Data date(s)

2012-2015

Limitations

The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.

Score

Foundational

m18
Number of epidemiologists per 100,000 population in the state, by quintile.
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction

Data date(s)

2012-2019

Limitations

The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

1.0

m19
State health department participates in the Epidemic Information Exchange (Epi-X) System.
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m20
State health department participates in the National Electronic Disease Surveillance System (NEDSS).
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013-2015

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m22
State health department has a syndromic surveillance system that can report and exchange information.
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012, 2016, & 2019

Limitations

Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.

Score

Yes

m217
State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies.
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m220
State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory.
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m256
State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet).
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

m23
Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed.
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

60.0%

m289
State health department participates in a broad prevention collaborative addressing health care associated infections (HAIs).
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.

Score

Foundational

m290
State has a public health veterinarian.
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015, 2017-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.

Score

Yes

m265
State uses an Electronic Death Registration System (EDRS).
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014-2018, 2020-2021

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.

Score

No

m801
State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network.
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.

9.5
Measure
Measure Description
Score
m1
Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise.
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2013

Limitations

The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.

Score

Foundational

m1314
State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA).
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results

Score

Yes

m208
State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service).
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m8
State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1).
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m9
State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines.
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m11
State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours.
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m12
State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory.
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.

Score

Yes

m211
Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella.
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

100.0%

m216
Percent of 15 to 21 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin-mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies. The 2018 CLSS survey added 6 more items (i.e., Ebola, Chikungunya, Zika, Lyme disease, Candida auris, and Mobilized colistin resistance (MCR 1)), increasing the total to 21 tests.
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

100.0%

m2
Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories.
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Laboratories may not undergo proficiency testing for all assay capabilities.

Score

100.0%

m3
Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.

Score

97.0%

m5
Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state's Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise.
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2013-2017

Limitations

The measure does not consider the public health laboratory's ability to process a large number of samples.

Score

100.0%

m7
Number of additional chemical agent detection methods-beyond the core methods-demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state.
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider all methods that the laboratory is capable of testing.

Score

4.0

m286
Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually.
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

2.0

m287
Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.

Score

97.0%

m288
Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state.
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.

Score

9.0

m911
State public health laboratory provides or assures testing for soil.
Measure Name

M911

Measure Source

Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m902
State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory).
Measure Name

M902

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)

Data date(s)

2016 & 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.

Score

Yes

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Community Planning & Engagement Coordination

cscc: cross sector community collaboration

arp: children other at risk populations

mvde: management of volunteers during emergencies

scc: social capital cohesion

This is best viewed on desktop.

The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.

4.5
Measure
Measure Description
Score
m87
State health department is accredited by the Public Health Accreditation Board (PHAB).
Measure Name

M87

Measure Source

Public Health Accreditation Board (PHAB), Health Departments in e-PHAB

Data date(s)

2013-2020

Limitations

The measure does not reflect health departments that are in process of achieving accreditation.

Score

No

m501
Percent of the state's population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems.
Measure Name

M501

Measure Source

National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.

Data date(s)

2012, 2014, 2016 & 2018

Limitations

Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.

Score

40.9%

m9031
Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9031

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

m9032
Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9032

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

15.1%

m9033
Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9033

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

10.1%

m9034
Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9034

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.

6.1
Measure
Measure Description
Score
m163
Number of pediatricians per 100,000 population under 18 years old in the state.
Measure Name

M163

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.

Score

84.8

m164
Number of obstetricians and gynecologists per 100,000 female population in the state.
Measure Name

M164

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.

Score

24.9

m170
Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers.
Measure Name

M170

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.

Score

97.2%

m53b
Percent of youth who missed one or more days of school in past month due to concerns about safety.
Measure Name

M53B

Measure Source

Youth Risk Behavior Survey

Data date(s)

2011, 2013, 2015, 2017 & 2019

Limitations

The measure is self-reported and does not distinguish reasons for safety concerns.

Score

6.1%

The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.

3.5
Measure
Measure Description
Score
m36
State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry.
Measure Name

M36

Measure Source

Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Data date(s)

2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.

Score

Foundational

m266
Percent of the state's population who live in a county with a Community Emergency Response Teams (CERT).
Measure Name

M266

Measure Source

Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016

Limitations

The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.

Score

76.4%

m346
Number of total Medical Reserve Corps members per 100,000 population in the state.
Measure Name

M346

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).

Score

122.9

m176
Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state.
Measure Name

M176

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.

Score

3.1

m179
Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state.
Measure Name

M179

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.

Score

35.3

m186
Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state.
Measure Name

M186

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.

Score

84.5

The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.

4.8
Measure
Measure Description
Score
m175
Percent of voting-eligible population in the state participating in the highest office election .
Measure Name

M175

Measure Source

United States Election Project, General Election Turnout Rates

Data date(s)

2012, 2014, 2016, 2018 & 2020

Limitations

The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).

Score

66.1%

m188
Percent of adults in the state who volunteer in their communities
Measure Name

M188

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.

Score

30.3%

m189
Number of annual volunteer hours per state resident, 15 years and older.
Measure Name

M189

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.

Score

38.2

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Incident & Information Management

incm: incident management

infm: information management

This is best viewed on desktop.

The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.

9.8
Measure
Measure Description
Score
m10
State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners.
Measure Name

M10

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2016

Limitations

The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.

Score

Foundational

m84
State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP).
Measure Name

M84

Measure Source

Emergency Management Accreditation Program (EMAP), Who Is Accredited?

Data date(s)

2014-2020

Limitations

The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.

Score

Yes

m107
Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii.
Measure Name

M107

Measure Source

National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments

Data date(s)

2013 & 2016

Limitations

The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.

Score

100.0%

m229
State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency.
Measure Name

M229

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.

Score

Foundational

m150
State uses a system for tracking hospital bed availability during emergencies.
Measure Name

M150

Measure Source

Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program

Data date(s)

2012-2018

Limitations

The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.

Score

Foundational

m701
Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty.
Measure Name

M701

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

52.0

m344
State has adopted or implemented the Nurse Licensure Compact (NLC).
Measure Name

M344

Measure Source

National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States

Data date(s)

2014-2020

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.

Score

Yes

m338
State requires health care facilities to report health care associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems.
Measure Name

M338

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report

Data date(s)

2012 & 2013

Limitations

The measure does not evaluate the health care facility compliance with reporting requirements.

Score

Foundational

m341
State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department.
Measure Name

M341

Measure Source

CDC Public Health Law Program resources. https://www.cdc.gov/phlp/

Data date(s)

2013

Limitations

The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.

Score

Foundational

m342
State law requires health care facilities to report communicable diseases to a health department.
Measure Name

M342

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013

Limitations

The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.

Score

Foundational

m345
State has adopted Emergency Management Assistance Compact (EMAC) legislation.
Measure Name

M345

Measure Source

National Emergency Management Association (NEMA)

Data date(s)

2014

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.

Score

Foundational

The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.

8.5
Measure
Measure Description
Score
m64
State has a public information and communication plan developed for a mass prophylaxis campaign.
Measure Name

M64

Measure Source

Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.

Data date(s)

2012-2018

Limitations

The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.

Score

Foundational

m228
Percent of households in the state with broadband in the home.
Measure Name

M228

Measure Source

American Community Survey (ACS), 1-year estimate (GCT2801).

Data date(s)

2012-2019

Limitations

The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.

Score

83.1%

m906
Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
Measure Name

M906

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

99.0%

m907
Percent of office-based medical doctors and doctors of osteopathy in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs.
Measure Name

M907

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

65.0%

m1001
The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure.
Measure Name

M1001

Measure Source

National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).

Data date(s)

2014-2019

Limitations

Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.

Score

Yes

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Health Care Delivery

pc: prehospital care

hps: hospital and physician services

ltc: long term care

mbh: mental behavioral health care

hc: home care

This is best viewed on desktop.

Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.

7.1
Measure
Measure Description
Score
m140
Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state.
Measure Name

M140

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

57.9

m331
Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state.
Measure Name

M331

Measure Source

National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information

Data date(s)

2015 & 2019

Limitations

The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.

Score

93.7%

m349
State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation.
Measure Name

M349

Measure Source

National Association of State EMS Officials

Data date(s)

2013-2018, 2020-2021

Limitations

Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.

Score

Yes

m350u
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas.
Measure Name

M350U

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

7.8

m350r
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas.
Measure Name

M350R

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

12.2

Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.

5.5
Measure
Measure Description
Score
m147
Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1).
Measure Name

M147

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2019

Limitations

The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.

Score

272.0

m148
Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2).
Measure Name

M148

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2020

Limitations

The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.

Score

91.0

m152
Percent of the state's population who live within 50 miles of a trauma center, including out-of-state centers.
Measure Name

M152

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.

Score

99.6%

m160
Number of physicians per 100,000 population in the state.
Measure Name

M160

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2011-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.

Score

85.6

m167
Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state.
Measure Name

M167

Measure Source

National Council of State Boards of Nursing (NCSBN), National Nursing Database

Data date(s)

2013-2016, 2018-2021

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.

Score

1,554.1

m168
Percent of the state's population living within 100 miles of a burn center, including out-of-state centers.
Measure Name

M168

Measure Source

American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.

Data date(s)

2014 & 2018

Limitations

The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.

Score

96.6%

m296
Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care).
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.

Score

41.9%

m297
Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program).
Measure Name

M297

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.

Score

39.5%

m298
Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states.
Measure Name

M298

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.

Score

45.0

m299
Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia.
Measure Name

M299

Measure Source

The Commonwealth Fund, Scorecard on State Health System Performance

Data date(s)

2011-2018

Limitations

Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.

Score

13.5%

m300
Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score.
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013-2020

Limitations

The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.

Score

44.4%

Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.

4.3
Measure
Measure Description
Score
m308
Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M308

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

0.8

m309
Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state.
Measure Name

M309

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

2.3

m307
Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine.
Measure Name

M307

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2013-2021

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

93.9%

m310
Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M310

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

1.1

m303b
Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (expressed as quintiles).
Measure Name

M303B

Measure Source

CMS Nursing Facility Inspection Reports

Data date(s)

2014-2020

Limitations

Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.

Score

5.0

m23nh
Number of disease outbreaks in nursing homes or assisted living facilities with a confirmed etiological agent (per 10,000 certified nursing home residents)
Measure Name

M23NH

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

States vary in their ability to detect and report outbreaks in long-term care settings.

Score

21.6

m880
Percentage of nursing home residents at facilities that did not have an infection control deficiency.
Measure Name

M880

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies

Data date(s)

2017-2020

Limitations

Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.

Score

49.2%

Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.

5.7
Measure
Measure Description
Score
m316
Percent of hospitals in the state providing psychiatric emergency services.
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.

Score

33.9%

m317
Percent of need met for mental health care in health professional shortage areas (HPSA) in the state.
Measure Name

M317

Measure Source

The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services

Data date(s)

2014, 2016-2020

Limitations

The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.

Score

57.4%

m800
Percent of the state's population not living in an HRSA Mental Health Professional Shortage Area.
Measure Name

M800

Measure Source

U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.

Data date(s)

2015-2020

Limitations

The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.

Score

71.1%

Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.

5.7
Measure
Measure Description
Score
m291
Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season.
Measure Name

M291

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

76.3%

m292
Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner.
Measure Name

M292

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality of the services provided including length of service delays.

Score

92.8%

m293
Number of home health and personal care aides per 1,000 population in the state aged 65 or older.
Measure Name

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)

Data date(s)

2012-2019

Limitations

The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.

Score

35.3

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Countermeasure Management

mmmdd: medical materiel management distribution dispensing

cue: countermeasure utilization effectiveness

This is best viewed on desktop.

The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.

4.1
Measure
Measure Description
Score
m60
State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements.
Measure Name

M60

Measure Source

CDC PHEP

Data date(s)

2012-2018

Limitations

The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.

Score

Foundational

m161
Number of Pharmacists per 100,000 population in the state.
Measure Name

M161

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

85.6

m270
Percent of hospitals in the state participating in a group purchasing arrangement.
Measure Name

M270

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.

Score

55.6%

The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.

5.6
Measure
Measure Description
Score
m24
Percent of children ages 19-35 months in the state receiving the recommended routine childhood combined 7-vaccine series (4:3:1:3*:3:1:4), which includes ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, the full series of Hib (≥3 or ≥4 doses, depending on product type), ≥3 doses of HepB, ≥1 dose of varicella vaccine, and ≥4 doses of PCV.
Measure Name

M24

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)

Data date(s)

2012-2019

Limitations

The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.

Score

64.4%

m32
Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination.
Measure Name

M32

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

69.5%

m33
Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination.
Measure Name

M33

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel.

Data date(s)

2012-2019

Limitations

The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.

Score

74.3%

m34
Percent of children aged 6 months to 4 years old in the state receiving a seasonal flu vaccination.
Measure Name

M34

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2012-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

74.7%

m35
Percent of adults aged 18 years and older in the state receiving a seasonal flu vaccination.
Measure Name

M35

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

46.0%

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Environmental & Occupational Health

fws: food water security

em: environmental monitoring

pei: physical environment and infrastructure

wr: workforce resiliency

This is best viewed on desktop.

The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.

9.3
Measure
Measure Description
Score
m275_dw
State public health laboratory provides or assures testing for drinking water.
Measure Name

M275_DW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

Yes

m275_pww
State public health laboratory provides or assures testing for private well water.
Measure Name

M275_PWW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_rec
State public health laboratory provides or assures testing for recreational water.
Measure Name

M275_REC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_sur
State public health laboratory provides or assures testing for surface water.
Measure Name

M275_SUR

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m275_wst
State public health laboratory provides or assu+M132res testing for waste water.
Measure Name

M275_WST

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m276
Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.
Measure Name

M276

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

100.0%

m195
Percentage of community water systems in a state that meet all applicable health-based standards.
Measure Name

M195

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

92.5%

m925
Percentage of community water systems in a state that meet all applicable non-health-based standards.
Measure Name

M925

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

83.9%

m23pc
Estimated total number of foodborne individual illness cases reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population).
Measure Name

M23PC

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

47.1

The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.

7.9
Measure
Measure Description
Score
m202
State public health laboratory provides or assures testing for air samples.
Measure Name

M202

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m257_aiha
State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA).
Measure Name

M257_AIHA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

No

m257_epa
State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA).
Measure Name

M257_EPA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m257_nelac
State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC).
Measure Name

M257_NELAC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m196
State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism.
Measure Name

M196

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Foundational

m272
Percent of 10 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds.
Measure Name

M272

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

90.0%

m273
State public health laboratory provides or assures testing for hazardous waste.
Measure Name

M273

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m274
State participates in the National Plant Diagnostic Network (NPDN).
Measure Name

M274

Measure Source

National Plant Diagnostic Network (NPDN), National Plant Diagnostic website

Data date(s)

2014

Limitations

The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.

Score

Foundational

m904
Number of environmental scientists and specialists (including health) per 100,000 population in the state.
Measure Name

M904

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041

Data date(s)

2012-2019

Limitations

The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

33.5

m23a
Number of disease outbreaks due to animal contact in a state where the etiological agent is confirm (per 1 million population).
Measure Name

M23A

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.

Score

0.1

Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.

6.7
Measure
Measure Description
Score
m922
Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor).
Measure Name

M922

Measure Source

U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures

Data date(s)

2012-2019

Limitations

The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.

Score

92.8%

m923
Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition.
Measure Name

M923

Measure Source

U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)

Data date(s)

2016, 2018 & 2019

Limitations

A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type.  Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states

Score

63.7%

m928
Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program.
Measure Name

M928

Measure Source

FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)

Data date(s)

2017-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP. 

Score

48.5%

m929
Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains.
Measure Name

M929

Measure Source

U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)

Data date(s)

2013-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP.  Also, many flood zone maps are outdated.

Score

47.8%

m334
State has a climate change adaptation plan.
Measure Name

M334

Measure Source

Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation

Data date(s)

2014-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.

Score

Yes

Actions taken to protect workers and emergency responders from health hazards while on the job.

5.0
Measure
Measure Description
Score
m530
Percent of employed workers in the state who used some type of paid time off (PTO) benefit.
Measure Name

M530

Measure Source

Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.

Data date(s)

2013-2020

Limitations

Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.

Score

59.9%

m531
Percent of employed population in the state engaging in some work from home by telecommuting.
Measure Name

M531

Measure Source

Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.

Data date(s)

2011-2013, 2015, 2017, 2019

Limitations

The measure data is estimated based on a survey of a sample of the general population.

Score

24.0%

m705
Percent of employed population (16 and older) in the state who work from home.
Measure Name

M705

Measure Source

American Community Survey (ACS), 1-year estimate (Table B08128)

Data date(s)

2012-2019

Limitations

The measure data does not include all individuals who can work at home on a "part-time" basis.

Score

4.6%

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Health Security Surveillance

phsei: health surveillance epidemiological investigation

bmlt: biological monitoring laboratory testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.

9.4
Measure
Measure Description
Score
m17
State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS).
Measure Name

M17

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.

Data date(s)

2012-2015

Limitations

The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.

Score

Foundational

m18
Number of epidemiologists per 100,000 population in the state, by quintile.
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction

Data date(s)

2012-2019

Limitations

The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

5.0

m19
State health department participates in the Epidemic Information Exchange (Epi-X) System.
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m20
State health department participates in the National Electronic Disease Surveillance System (NEDSS).
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013-2015

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m22
State health department has a syndromic surveillance system that can report and exchange information.
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012, 2016, & 2019

Limitations

Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.

Score

Yes

m217
State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies.
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m220
State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory.
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m256
State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet).
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

m23
Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed.
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

55.6%

m289
State health department participates in a broad prevention collaborative addressing health care associated infections (HAIs).
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.

Score

Foundational

m290
State has a public health veterinarian.
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015, 2017-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.

Score

Yes

m265
State uses an Electronic Death Registration System (EDRS).
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014-2018, 2020-2021

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.

Score

Yes

m801
State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network.
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.

9.6
Measure
Measure Description
Score
m1
Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise.
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2013

Limitations

The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.

Score

Foundational

m1314
State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA).
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results

Score

Yes

m208
State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service).
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m8
State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1).
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m9
State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines.
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m11
State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours.
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m12
State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory.
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.

Score

Yes

m211
Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella.
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

100.0%

m216
Percent of 15 to 21 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin-mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies. The 2018 CLSS survey added 6 more items (i.e., Ebola, Chikungunya, Zika, Lyme disease, Candida auris, and Mobilized colistin resistance (MCR 1)), increasing the total to 21 tests.
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

100.0%

m2
Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories.
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Laboratories may not undergo proficiency testing for all assay capabilities.

Score

100.0%

m3
Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.

Score

100.0%

m5
Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state's Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise.
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2013-2017

Limitations

The measure does not consider the public health laboratory's ability to process a large number of samples.

Score

100.0%

m7
Number of additional chemical agent detection methods-beyond the core methods-demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state.
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider all methods that the laboratory is capable of testing.

Score

4.0

m286
Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually.
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

7.0

m287
Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.

Score

100.0%

m288
Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state.
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.

Score

9.0

m911
State public health laboratory provides or assures testing for soil.
Measure Name

M911

Measure Source

Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m902
State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory).
Measure Name

M902

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)

Data date(s)

2016 & 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.

Score

Yes

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Community Planning & Engagement Coordination

cscc: cross sector community collaboration

arp: children other at risk populations

mvde: management of volunteers during emergencies

scc: social capital cohesion

This is best viewed on desktop.

The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.

6.6
Measure
Measure Description
Score
m87
State health department is accredited by the Public Health Accreditation Board (PHAB).
Measure Name

M87

Measure Source

Public Health Accreditation Board (PHAB), Health Departments in e-PHAB

Data date(s)

2013-2020

Limitations

The measure does not reflect health departments that are in process of achieving accreditation.

Score

No

m501
Percent of the state's population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems.
Measure Name

M501

Measure Source

National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.

Data date(s)

2012, 2014, 2016 & 2018

Limitations

Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.

Score

40.9%

m9031
Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9031

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

m9032
Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9032

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

82.9%

m9033
Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9033

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

67.7%

m9034
Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9034

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.

5.8
Measure
Measure Description
Score
m163
Number of pediatricians per 100,000 population under 18 years old in the state.
Measure Name

M163

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.

Score

84.7

m164
Number of obstetricians and gynecologists per 100,000 female population in the state.
Measure Name

M164

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.

Score

24.7

m170
Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers.
Measure Name

M170

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.

Score

97.1%

m53b
Percent of youth who missed one or more days of school in past month due to concerns about safety.
Measure Name

M53B

Measure Source

Youth Risk Behavior Survey

Data date(s)

2011, 2013, 2015, 2017 & 2019

Limitations

The measure is self-reported and does not distinguish reasons for safety concerns.

Score

7.1%

The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.

3.5
Measure
Measure Description
Score
m36
State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry.
Measure Name

M36

Measure Source

Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Data date(s)

2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.

Score

Foundational

m266
Percent of the state's population who live in a county with a Community Emergency Response Teams (CERT).
Measure Name

M266

Measure Source

Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016

Limitations

The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.

Score

76.4%

m346
Number of total Medical Reserve Corps members per 100,000 population in the state.
Measure Name

M346

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).

Score

119.4

m176
Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state.
Measure Name

M176

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.

Score

3.2

m179
Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state.
Measure Name

M179

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.

Score

34.3

m186
Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state.
Measure Name

M186

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.

Score

81.9

The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.

4.9
Measure
Measure Description
Score
m175
Percent of voting-eligible population in the state participating in the highest office election .
Measure Name

M175

Measure Source

United States Election Project, General Election Turnout Rates

Data date(s)

2012, 2014, 2016, 2018 & 2020

Limitations

The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).

Score

66.1%

m188
Percent of adults in the state who volunteer in their communities
Measure Name

M188

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.

Score

34.0%

m189
Number of annual volunteer hours per state resident, 15 years and older.
Measure Name

M189

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.

Score

33.5

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Incident & Information Management

incm: incident management

infm: information management

This is best viewed on desktop.

The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.

10.0
Measure
Measure Description
Score
m10
State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners.
Measure Name

M10

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2016

Limitations

The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.

Score

Foundational

m84
State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP).
Measure Name

M84

Measure Source

Emergency Management Accreditation Program (EMAP), Who Is Accredited?

Data date(s)

2014-2020

Limitations

The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.

Score

Yes

m107
Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii.
Measure Name

M107

Measure Source

National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments

Data date(s)

2013 & 2016

Limitations

The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.

Score

100.0%

m229
State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency.
Measure Name

M229

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.

Score

Foundational

m150
State uses a system for tracking hospital bed availability during emergencies.
Measure Name

M150

Measure Source

Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program

Data date(s)

2012-2018

Limitations

The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.

Score

Foundational

m701
Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty.
Measure Name

M701

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

9.0

m344
State has adopted or implemented the Nurse Licensure Compact (NLC).
Measure Name

M344

Measure Source

National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States

Data date(s)

2014-2020

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.

Score

Yes

m338
State requires health care facilities to report health care associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems.
Measure Name

M338

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report

Data date(s)

2012 & 2013

Limitations

The measure does not evaluate the health care facility compliance with reporting requirements.

Score

Foundational

m341
State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department.
Measure Name

M341

Measure Source

CDC Public Health Law Program resources. https://www.cdc.gov/phlp/

Data date(s)

2013

Limitations

The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.

Score

Foundational

m342
State law requires health care facilities to report communicable diseases to a health department.
Measure Name

M342

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013

Limitations

The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.

Score

Foundational

m345
State has adopted Emergency Management Assistance Compact (EMAC) legislation.
Measure Name

M345

Measure Source

National Emergency Management Association (NEMA)

Data date(s)

2014

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.

Score

Foundational

The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.

8.5
Measure
Measure Description
Score
m64
State has a public information and communication plan developed for a mass prophylaxis campaign.
Measure Name

M64

Measure Source

Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.

Data date(s)

2012-2018

Limitations

The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.

Score

Foundational

m228
Percent of households in the state with broadband in the home.
Measure Name

M228

Measure Source

American Community Survey (ACS), 1-year estimate (GCT2801).

Data date(s)

2012-2019

Limitations

The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.

Score

83.4%

m906
Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
Measure Name

M906

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

99.0%

m907
Percent of office-based medical doctors and doctors of osteopathy in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs.
Measure Name

M907

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

65.0%

m1001
The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure.
Measure Name

M1001

Measure Source

National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).

Data date(s)

2014-2019

Limitations

Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.

Score

Yes

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Health Care Delivery

pc: prehospital care

hps: hospital and physician services

ltc: long term care

mbh: mental behavioral health care

hc: home care

This is best viewed on desktop.

Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.

7.0
Measure
Measure Description
Score
m140
Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state.
Measure Name

M140

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

60.7

m331
Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state.
Measure Name

M331

Measure Source

National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information

Data date(s)

2015 & 2019

Limitations

The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.

Score

93.7%

m349
State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation.
Measure Name

M349

Measure Source

National Association of State EMS Officials

Data date(s)

2013-2018, 2020-2021

Limitations

Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.

Score

Yes

m350u
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas.
Measure Name

M350U

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

10.5

m350r
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas.
Measure Name

M350R

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

12.4

Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.

5.8
Measure
Measure Description
Score
m147
Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1).
Measure Name

M147

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2019

Limitations

The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.

Score

276.0

m148
Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2).
Measure Name

M148

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2020

Limitations

The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.

Score

91.0

m152
Percent of the state's population who live within 50 miles of a trauma center, including out-of-state centers.
Measure Name

M152

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.

Score

99.5%

m160
Number of physicians per 100,000 population in the state.
Measure Name

M160

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2011-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.

Score

85.6

m167
Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state.
Measure Name

M167

Measure Source

National Council of State Boards of Nursing (NCSBN), National Nursing Database

Data date(s)

2013-2016, 2018-2021

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.

Score

1,568.6

m168
Percent of the state's population living within 100 miles of a burn center, including out-of-state centers.
Measure Name

M168

Measure Source

American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.

Data date(s)

2014 & 2018

Limitations

The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.

Score

96.6%

m296
Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care).
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.

Score

38.7%

m297
Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program).
Measure Name

M297

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.

Score

39.5%

m298
Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states.
Measure Name

M298

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.

Score

42.8

m299
Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia.
Measure Name

M299

Measure Source

The Commonwealth Fund, Scorecard on State Health System Performance

Data date(s)

2011-2018

Limitations

Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.

Score

14.5%

m300
Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score.
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013-2020

Limitations

The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.

Score

60.3%

Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.

4.6
Measure
Measure Description
Score
m308
Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M308

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

0.8

m309
Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state.
Measure Name

M309

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

2.3

m307
Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine.
Measure Name

M307

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2013-2021

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

94.8%

m310
Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M310

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

1.1

m303b
Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (expressed as quintiles).
Measure Name

M303B

Measure Source

CMS Nursing Facility Inspection Reports

Data date(s)

2014-2020

Limitations

Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.

Score

5.0

m23nh
Number of disease outbreaks in nursing homes or assisted living facilities with a confirmed etiological agent (per 10,000 certified nursing home residents)
Measure Name

M23NH

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

States vary in their ability to detect and report outbreaks in long-term care settings.

Score

11.9

m880
Percentage of nursing home residents at facilities that did not have an infection control deficiency.
Measure Name

M880

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies

Data date(s)

2017-2020

Limitations

Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.

Score

49.2%

Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.

5.1
Measure
Measure Description
Score
m316
Percent of hospitals in the state providing psychiatric emergency services.
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.

Score

32.3%

m317
Percent of need met for mental health care in health professional shortage areas (HPSA) in the state.
Measure Name

M317

Measure Source

The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services

Data date(s)

2014, 2016-2020

Limitations

The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.

Score

40.7%

m800
Percent of the state's population not living in an HRSA Mental Health Professional Shortage Area.
Measure Name

M800

Measure Source

U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.

Data date(s)

2015-2020

Limitations

The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.

Score

73.2%

Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.

6.3
Measure
Measure Description
Score
m291
Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season.
Measure Name

M291

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

79.9%

m292
Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner.
Measure Name

M292

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality of the services provided including length of service delays.

Score

93.7%

m293
Number of home health and personal care aides per 1,000 population in the state aged 65 or older.
Measure Name

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)

Data date(s)

2012-2019

Limitations

The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.

Score

35.0

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Countermeasure Management

mmmdd: medical materiel management distribution dispensing

cue: countermeasure utilization effectiveness

This is best viewed on desktop.

The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.

4.0
Measure
Measure Description
Score
m60
State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements.
Measure Name

M60

Measure Source

CDC PHEP

Data date(s)

2012-2018

Limitations

The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.

Score

Foundational

m161
Number of Pharmacists per 100,000 population in the state.
Measure Name

M161

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

83.2

m270
Percent of hospitals in the state participating in a group purchasing arrangement.
Measure Name

M270

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.

Score

55.6%

The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.

5.9
Measure
Measure Description
Score
m24
Percent of children ages 19-35 months in the state receiving the recommended routine childhood combined 7-vaccine series (4:3:1:3*:3:1:4), which includes ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, the full series of Hib (≥3 or ≥4 doses, depending on product type), ≥3 doses of HepB, ≥1 dose of varicella vaccine, and ≥4 doses of PCV.
Measure Name

M24

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)

Data date(s)

2012-2019

Limitations

The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.

Score

65.9%

m32
Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination.
Measure Name

M32

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

67.1%

m33
Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination.
Measure Name

M33

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel.

Data date(s)

2012-2019

Limitations

The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.

Score

75.9%

m34
Percent of children aged 6 months to 4 years old in the state receiving a seasonal flu vaccination.
Measure Name

M34

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2012-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

73.9%

m35
Percent of adults aged 18 years and older in the state receiving a seasonal flu vaccination.
Measure Name

M35

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

47.9%

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Environmental & Occupational Health

fws: food water security

em: environmental monitoring

pei: physical environment and infrastructure

wr: workforce resiliency

This is best viewed on desktop.

The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.

9.5
Measure
Measure Description
Score
m275_dw
State public health laboratory provides or assures testing for drinking water.
Measure Name

M275_DW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

Yes

m275_pww
State public health laboratory provides or assures testing for private well water.
Measure Name

M275_PWW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_rec
State public health laboratory provides or assures testing for recreational water.
Measure Name

M275_REC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_sur
State public health laboratory provides or assures testing for surface water.
Measure Name

M275_SUR

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m275_wst
State public health laboratory provides or assu+M132res testing for waste water.
Measure Name

M275_WST

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m276
Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.
Measure Name

M276

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

100.0%

m195
Percentage of community water systems in a state that meet all applicable health-based standards.
Measure Name

M195

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

95.7%

m925
Percentage of community water systems in a state that meet all applicable non-health-based standards.
Measure Name

M925

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

84.4%

m23pc
Estimated total number of foodborne individual illness cases reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population).
Measure Name

M23PC

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

13.8

The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.

7.9
Measure
Measure Description
Score
m202
State public health laboratory provides or assures testing for air samples.
Measure Name

M202

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m257_aiha
State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA).
Measure Name

M257_AIHA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

No

m257_epa
State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA).
Measure Name

M257_EPA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m257_nelac
State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC).
Measure Name

M257_NELAC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m196
State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism.
Measure Name

M196

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Foundational

m272
Percent of 10 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds.
Measure Name

M272

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

90.0%

m273
State public health laboratory provides or assures testing for hazardous waste.
Measure Name

M273

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m274
State participates in the National Plant Diagnostic Network (NPDN).
Measure Name

M274

Measure Source

National Plant Diagnostic Network (NPDN), National Plant Diagnostic website

Data date(s)

2014

Limitations

The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.

Score

Foundational

m904
Number of environmental scientists and specialists (including health) per 100,000 population in the state.
Measure Name

M904

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041

Data date(s)

2012-2019

Limitations

The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

33.8

m23a
Number of disease outbreaks due to animal contact in a state where the etiological agent is confirm (per 1 million population).
Measure Name

M23A

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.

Score

0.0

Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.

6.8
Measure
Measure Description
Score
m922
Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor).
Measure Name

M922

Measure Source

U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures

Data date(s)

2012-2019

Limitations

The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.

Score

93.7%

m923
Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition.
Measure Name

M923

Measure Source

U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)

Data date(s)

2016, 2018 & 2019

Limitations

A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type.  Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states

Score

63.7%

m928
Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program.
Measure Name

M928

Measure Source

FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)

Data date(s)

2017-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP. 

Score

48.5%

m929
Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains.
Measure Name

M929

Measure Source

U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)

Data date(s)

2013-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP.  Also, many flood zone maps are outdated.

Score

49.2%

m334
State has a climate change adaptation plan.
Measure Name

M334

Measure Source

Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation

Data date(s)

2014-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.

Score

Yes

Actions taken to protect workers and emergency responders from health hazards while on the job.

5.2
Measure
Measure Description
Score
m530
Percent of employed workers in the state who used some type of paid time off (PTO) benefit.
Measure Name

M530

Measure Source

Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.

Data date(s)

2013-2020

Limitations

Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.

Score

60.3%

m531
Percent of employed population in the state engaging in some work from home by telecommuting.
Measure Name

M531

Measure Source

Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.

Data date(s)

2011-2013, 2015, 2017, 2019

Limitations

The measure data is estimated based on a survey of a sample of the general population.

Score

24.0%

m705
Percent of employed population (16 and older) in the state who work from home.
Measure Name

M705

Measure Source

American Community Survey (ACS), 1-year estimate (Table B08128)

Data date(s)

2012-2019

Limitations

The measure data does not include all individuals who can work at home on a "part-time" basis.

Score

5.0%

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Health Security Surveillance

phsei: health surveillance epidemiological investigation

bmlt: biological monitoring laboratory testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.

8.7
Measure
Measure Description
Score
m17
State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS).
Measure Name

M17

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.

Data date(s)

2012-2015

Limitations

The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.

Score

Foundational

m18
Number of epidemiologists per 100,000 population in the state, by quintile.
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction

Data date(s)

2012-2019

Limitations

The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

2.0

m19
State health department participates in the Epidemic Information Exchange (Epi-X) System.
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m20
State health department participates in the National Electronic Disease Surveillance System (NEDSS).
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013-2015

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m22
State health department has a syndromic surveillance system that can report and exchange information.
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012, 2016, & 2019

Limitations

Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.

Score

Yes

m217
State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies.
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m220
State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory.
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m256
State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet).
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

m23
Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed.
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

75.0%

m289
State health department participates in a broad prevention collaborative addressing health care associated infections (HAIs).
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.

Score

Foundational

m290
State has a public health veterinarian.
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015, 2017-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.

Score

Yes

m265
State uses an Electronic Death Registration System (EDRS).
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014-2018, 2020-2021

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.

Score

Yes

m801
State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network.
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.

9.5
Measure
Measure Description
Score
m1
Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise.
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2013

Limitations

The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.

Score

Foundational

m1314
State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA).
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results

Score

Yes

m208
State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service).
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m8
State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1).
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m9
State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines.
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m11
State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours.
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m12
State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory.
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.

Score

Yes

m211
Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella.
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

100.0%

m216
Percent of 15 to 21 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin-mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies. The 2018 CLSS survey added 6 more items (i.e., Ebola, Chikungunya, Zika, Lyme disease, Candida auris, and Mobilized colistin resistance (MCR 1)), increasing the total to 21 tests.
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

100.0%

m2
Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories.
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Laboratories may not undergo proficiency testing for all assay capabilities.

Score

100.0%

m3
Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.

Score

100.0%

m5
Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state's Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise.
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2013-2017

Limitations

The measure does not consider the public health laboratory's ability to process a large number of samples.

Score

100.0%

m7
Number of additional chemical agent detection methods-beyond the core methods-demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state.
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider all methods that the laboratory is capable of testing.

Score

4.0

m286
Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually.
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

5.0

m287
Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.

Score

92.0%

m288
Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state.
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.

Score

9.0

m911
State public health laboratory provides or assures testing for soil.
Measure Name

M911

Measure Source

Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m902
State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory).
Measure Name

M902

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)

Data date(s)

2016 & 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.

Score

Yes

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Community Planning & Engagement Coordination

cscc: cross sector community collaboration

arp: children other at risk populations

mvde: management of volunteers during emergencies

scc: social capital cohesion

This is best viewed on desktop.

The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.

6.7
Measure
Measure Description
Score
m87
State health department is accredited by the Public Health Accreditation Board (PHAB).
Measure Name

M87

Measure Source

Public Health Accreditation Board (PHAB), Health Departments in e-PHAB

Data date(s)

2013-2020

Limitations

The measure does not reflect health departments that are in process of achieving accreditation.

Score

No

m501
Percent of the state's population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems.
Measure Name

M501

Measure Source

National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.

Data date(s)

2012, 2014, 2016 & 2018

Limitations

Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.

Score

44.0%

m9031
Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9031

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

m9032
Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9032

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

82.9%

m9033
Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9033

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

67.7%

m9034
Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9034

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.

5.8
Measure
Measure Description
Score
m163
Number of pediatricians per 100,000 population under 18 years old in the state.
Measure Name

M163

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.

Score

84.7

m164
Number of obstetricians and gynecologists per 100,000 female population in the state.
Measure Name

M164

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.

Score

24.6

m170
Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers.
Measure Name

M170

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.

Score

97.1%

m53b
Percent of youth who missed one or more days of school in past month due to concerns about safety.
Measure Name

M53B

Measure Source

Youth Risk Behavior Survey

Data date(s)

2011, 2013, 2015, 2017 & 2019

Limitations

The measure is self-reported and does not distinguish reasons for safety concerns.

Score

7.1%

The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.

3.2
Measure
Measure Description
Score
m36
State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry.
Measure Name

M36

Measure Source

Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Data date(s)

2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.

Score

Foundational

m266
Percent of the state's population who live in a county with a Community Emergency Response Teams (CERT).
Measure Name

M266

Measure Source

Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016

Limitations

The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.

Score

76.4%

m346
Number of total Medical Reserve Corps members per 100,000 population in the state.
Measure Name

M346

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).

Score

107.8

m176
Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state.
Measure Name

M176

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.

Score

2.7

m179
Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state.
Measure Name

M179

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.

Score

30.3

m186
Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state.
Measure Name

M186

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.

Score

74.8

The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.

4.9
Measure
Measure Description
Score
m175
Percent of voting-eligible population in the state participating in the highest office election .
Measure Name

M175

Measure Source

United States Election Project, General Election Turnout Rates

Data date(s)

2012, 2014, 2016, 2018 & 2020

Limitations

The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).

Score

66.1%

m188
Percent of adults in the state who volunteer in their communities
Measure Name

M188

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.

Score

34.0%

m189
Number of annual volunteer hours per state resident, 15 years and older.
Measure Name

M189

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.

Score

33.5

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Incident & Information Management

incm: incident management

infm: information management

This is best viewed on desktop.

The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.

9.9
Measure
Measure Description
Score
m10
State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners.
Measure Name

M10

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2016

Limitations

The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.

Score

Foundational

m84
State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP).
Measure Name

M84

Measure Source

Emergency Management Accreditation Program (EMAP), Who Is Accredited?

Data date(s)

2014-2020

Limitations

The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.

Score

Yes

m107
Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii.
Measure Name

M107

Measure Source

National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments

Data date(s)

2013 & 2016

Limitations

The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.

Score

100.0%

m229
State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency.
Measure Name

M229

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.

Score

Foundational

m150
State uses a system for tracking hospital bed availability during emergencies.
Measure Name

M150

Measure Source

Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program

Data date(s)

2012-2018

Limitations

The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.

Score

Foundational

m701
Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty.
Measure Name

M701

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

43.0

m344
State has adopted or implemented the Nurse Licensure Compact (NLC).
Measure Name

M344

Measure Source

National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States

Data date(s)

2014-2020

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.

Score

Yes

m338
State requires health care facilities to report health care associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems.
Measure Name

M338

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report

Data date(s)

2012 & 2013

Limitations

The measure does not evaluate the health care facility compliance with reporting requirements.

Score

Foundational

m341
State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department.
Measure Name

M341

Measure Source

CDC Public Health Law Program resources. https://www.cdc.gov/phlp/

Data date(s)

2013

Limitations

The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.

Score

Foundational

m342
State law requires health care facilities to report communicable diseases to a health department.
Measure Name

M342

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013

Limitations

The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.

Score

Foundational

m345
State has adopted Emergency Management Assistance Compact (EMAC) legislation.
Measure Name

M345

Measure Source

National Emergency Management Association (NEMA)

Data date(s)

2014

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.

Score

Foundational

The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.

8.7
Measure
Measure Description
Score
m64
State has a public information and communication plan developed for a mass prophylaxis campaign.
Measure Name

M64

Measure Source

Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.

Data date(s)

2012-2018

Limitations

The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.

Score

Foundational

m228
Percent of households in the state with broadband in the home.
Measure Name

M228

Measure Source

American Community Survey (ACS), 1-year estimate (GCT2801).

Data date(s)

2012-2019

Limitations

The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.

Score

84.8%

m906
Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
Measure Name

M906

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

99.0%

m907
Percent of office-based medical doctors and doctors of osteopathy in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs.
Measure Name

M907

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

65.0%

m1001
The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure.
Measure Name

M1001

Measure Source

National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).

Data date(s)

2014-2019

Limitations

Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.

Score

Yes

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Health Care Delivery

pc: prehospital care

hps: hospital and physician services

ltc: long term care

mbh: mental behavioral health care

hc: home care

This is best viewed on desktop.

Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.

5.4
Measure
Measure Description
Score
m140
Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state.
Measure Name

M140

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

69.4

m331
Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state.
Measure Name

M331

Measure Source

National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information

Data date(s)

2015 & 2019

Limitations

The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.

Score

32.0%

m349
State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation.
Measure Name

M349

Measure Source

National Association of State EMS Officials

Data date(s)

2013-2018, 2020-2021

Limitations

Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.

Score

Yes

m350u
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas.
Measure Name

M350U

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

10.5

m350r
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas.
Measure Name

M350R

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

12.4

Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.

5.8
Measure
Measure Description
Score
m147
Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1).
Measure Name

M147

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2019

Limitations

The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.

Score

275.0

m148
Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2).
Measure Name

M148

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2020

Limitations

The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.

Score

91.0

m152
Percent of the state's population who live within 50 miles of a trauma center, including out-of-state centers.
Measure Name

M152

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.

Score

98.6%

m160
Number of physicians per 100,000 population in the state.
Measure Name

M160

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2011-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.

Score

85.7

m167
Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state.
Measure Name

M167

Measure Source

National Council of State Boards of Nursing (NCSBN), National Nursing Database

Data date(s)

2013-2016, 2018-2021

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.

Score

1,585.1

m168
Percent of the state's population living within 100 miles of a burn center, including out-of-state centers.
Measure Name

M168

Measure Source

American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.

Data date(s)

2014 & 2018

Limitations

The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.

Score

96.6%

m296
Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care).
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.

Score

43.6%

m297
Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program).
Measure Name

M297

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.

Score

41.1%

m298
Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states.
Measure Name

M298

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.

Score

40.1

m299
Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia.
Measure Name

M299

Measure Source

The Commonwealth Fund, Scorecard on State Health System Performance

Data date(s)

2011-2018

Limitations

Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.

Score

14.1%

m300
Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score.
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013-2020

Limitations

The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.

Score

60.3%

Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.

5.3
Measure
Measure Description
Score
m308
Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M308

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

0.6

m309
Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state.
Measure Name

M309

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

2.1

m307
Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine.
Measure Name

M307

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2013-2021

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

95.7%

m310
Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M310

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

1.1

m303b
Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (expressed as quintiles).
Measure Name

M303B

Measure Source

CMS Nursing Facility Inspection Reports

Data date(s)

2014-2020

Limitations

Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.

Score

4.0

m23nh
Number of disease outbreaks in nursing homes or assisted living facilities with a confirmed etiological agent (per 10,000 certified nursing home residents)
Measure Name

M23NH

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

States vary in their ability to detect and report outbreaks in long-term care settings.

Score

10.1

m880
Percentage of nursing home residents at facilities that did not have an infection control deficiency.
Measure Name

M880

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies

Data date(s)

2017-2020

Limitations

Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.

Score

64.2%

Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.

5.5
Measure
Measure Description
Score
m316
Percent of hospitals in the state providing psychiatric emergency services.
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.

Score

42.7%

m317
Percent of need met for mental health care in health professional shortage areas (HPSA) in the state.
Measure Name

M317

Measure Source

The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services

Data date(s)

2014, 2016-2020

Limitations

The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.

Score

39.9%

m800
Percent of the state's population not living in an HRSA Mental Health Professional Shortage Area.
Measure Name

M800

Measure Source

U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.

Data date(s)

2015-2020

Limitations

The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.

Score

72.2%

Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.

6.6
Measure
Measure Description
Score
m291
Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season.
Measure Name

M291

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

81.9%

m292
Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner.
Measure Name

M292

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality of the services provided including length of service delays.

Score

94.1%

m293
Number of home health and personal care aides per 1,000 population in the state aged 65 or older.
Measure Name

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)

Data date(s)

2012-2019

Limitations

The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.

Score

33.8

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Countermeasure Management

mmmdd: medical materiel management distribution dispensing

cue: countermeasure utilization effectiveness

This is best viewed on desktop.

The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.

3.7
Measure
Measure Description
Score
m60
State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements.
Measure Name

M60

Measure Source

CDC PHEP

Data date(s)

2012-2018

Limitations

The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.

Score

Foundational

m161
Number of Pharmacists per 100,000 population in the state.
Measure Name

M161

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

82.4

m270
Percent of hospitals in the state participating in a group purchasing arrangement.
Measure Name

M270

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.

Score

50.8%

The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.

6.8
Measure
Measure Description
Score
m24
Percent of children ages 19-35 months in the state receiving the recommended routine childhood combined 7-vaccine series (4:3:1:3*:3:1:4), which includes ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, the full series of Hib (≥3 or ≥4 doses, depending on product type), ≥3 doses of HepB, ≥1 dose of varicella vaccine, and ≥4 doses of PCV.
Measure Name

M24

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)

Data date(s)

2012-2019

Limitations

The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.

Score

77.1%

m32
Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination.
Measure Name

M32

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

65.2%

m33
Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination.
Measure Name

M33

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel.

Data date(s)

2012-2019

Limitations

The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.

Score

77.1%

m34
Percent of children aged 6 months to 4 years old in the state receiving a seasonal flu vaccination.
Measure Name

M34

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2012-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

83.1%

m35
Percent of adults aged 18 years and older in the state receiving a seasonal flu vaccination.
Measure Name

M35

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

43.4%

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Environmental & Occupational Health

fws: food water security

em: environmental monitoring

pei: physical environment and infrastructure

wr: workforce resiliency

This is best viewed on desktop.

The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.

9.5
Measure
Measure Description
Score
m275_dw
State public health laboratory provides or assures testing for drinking water.
Measure Name

M275_DW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

Yes

m275_pww
State public health laboratory provides or assures testing for private well water.
Measure Name

M275_PWW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_rec
State public health laboratory provides or assures testing for recreational water.
Measure Name

M275_REC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_sur
State public health laboratory provides or assures testing for surface water.
Measure Name

M275_SUR

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m275_wst
State public health laboratory provides or assu+M132res testing for waste water.
Measure Name

M275_WST

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m276
Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.
Measure Name

M276

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

100.0%

m195
Percentage of community water systems in a state that meet all applicable health-based standards.
Measure Name

M195

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

95.7%

m925
Percentage of community water systems in a state that meet all applicable non-health-based standards.
Measure Name

M925

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

87.2%

m23pc
Estimated total number of foodborne individual illness cases reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population).
Measure Name

M23PC

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

67.2

The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.

7.9
Measure
Measure Description
Score
m202
State public health laboratory provides or assures testing for air samples.
Measure Name

M202

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m257_aiha
State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA).
Measure Name

M257_AIHA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

No

m257_epa
State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA).
Measure Name

M257_EPA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m257_nelac
State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC).
Measure Name

M257_NELAC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m196
State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism.
Measure Name

M196

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Foundational

m272
Percent of 10 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds.
Measure Name

M272

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

90.0%

m273
State public health laboratory provides or assures testing for hazardous waste.
Measure Name

M273

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m274
State participates in the National Plant Diagnostic Network (NPDN).
Measure Name

M274

Measure Source

National Plant Diagnostic Network (NPDN), National Plant Diagnostic website

Data date(s)

2014

Limitations

The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.

Score

Foundational

m904
Number of environmental scientists and specialists (including health) per 100,000 population in the state.
Measure Name

M904

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041

Data date(s)

2012-2019

Limitations

The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

33.2

m23a
Number of disease outbreaks due to animal contact in a state where the etiological agent is confirm (per 1 million population).
Measure Name

M23A

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.

Score

0.0

Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.

6.4
Measure
Measure Description
Score
m922
Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor).
Measure Name

M922

Measure Source

U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures

Data date(s)

2012-2019

Limitations

The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.

Score

94.5%

m923
Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition.
Measure Name

M923

Measure Source

U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)

Data date(s)

2016, 2018 & 2019

Limitations

A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type.  Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states

Score

42.1%

m928
Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program.
Measure Name

M928

Measure Source

FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)

Data date(s)

2017-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP. 

Score

48.8%

m929
Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains.
Measure Name

M929

Measure Source

U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)

Data date(s)

2013-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP.  Also, many flood zone maps are outdated.

Score

48.9%

m334
State has a climate change adaptation plan.
Measure Name

M334

Measure Source

Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation

Data date(s)

2014-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.

Score

Yes

Actions taken to protect workers and emergency responders from health hazards while on the job.

4.9
Measure
Measure Description
Score
m530
Percent of employed workers in the state who used some type of paid time off (PTO) benefit.
Measure Name

M530

Measure Source

Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.

Data date(s)

2013-2020

Limitations

Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.

Score

58.0%

m531
Percent of employed population in the state engaging in some work from home by telecommuting.
Measure Name

M531

Measure Source

Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.

Data date(s)

2011-2013, 2015, 2017, 2019

Limitations

The measure data is estimated based on a survey of a sample of the general population.

Score

22.5%

m705
Percent of employed population (16 and older) in the state who work from home.
Measure Name

M705

Measure Source

American Community Survey (ACS), 1-year estimate (Table B08128)

Data date(s)

2012-2019

Limitations

The measure data does not include all individuals who can work at home on a "part-time" basis.

Score

5.4%

Close Window

Health Security Surveillance

phsei: health surveillance epidemiological investigation

bmlt: biological monitoring laboratory testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.

8.9
Measure
Measure Description
Score
m17
State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS).
Measure Name

M17

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.

Data date(s)

2012-2015

Limitations

The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.

Score

Foundational

m18
Number of epidemiologists per 100,000 population in the state, by quintile.
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction

Data date(s)

2012-2019

Limitations

The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

3.0

m19
State health department participates in the Epidemic Information Exchange (Epi-X) System.
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m20
State health department participates in the National Electronic Disease Surveillance System (NEDSS).
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013-2015

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m22
State health department has a syndromic surveillance system that can report and exchange information.
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012, 2016, & 2019

Limitations

Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.

Score

Yes

m217
State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies.
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m220
State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory.
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m256
State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet).
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

m23
Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed.
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

66.7%

m289
State health department participates in a broad prevention collaborative addressing health care associated infections (HAIs).
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.

Score

Foundational

m290
State has a public health veterinarian.
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015, 2017-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.

Score

Yes

m265
State uses an Electronic Death Registration System (EDRS).
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014-2018, 2020-2021

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.

Score

Yes

m801
State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network.
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.

9.7
Measure
Measure Description
Score
m1
Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise.
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2013

Limitations

The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.

Score

Foundational

m1314
State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA).
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results

Score

Yes

m208
State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service).
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m8
State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1).
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m9
State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines.
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m11
State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours.
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m12
State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory.
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.

Score

Yes

m211
Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella.
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

100.0%

m216
Percent of 15 to 21 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin-mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies. The 2018 CLSS survey added 6 more items (i.e., Ebola, Chikungunya, Zika, Lyme disease, Candida auris, and Mobilized colistin resistance (MCR 1)), increasing the total to 21 tests.
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

100.0%

m2
Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories.
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Laboratories may not undergo proficiency testing for all assay capabilities.

Score

100.0%

m3
Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.

Score

98.0%

m5
Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state's Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise.
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2013-2017

Limitations

The measure does not consider the public health laboratory's ability to process a large number of samples.

Score

100.0%

m7
Number of additional chemical agent detection methods-beyond the core methods-demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state.
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider all methods that the laboratory is capable of testing.

Score

4.0

m286
Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually.
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

11.0

m287
Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.

Score

100.0%

m288
Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state.
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.

Score

9.0

m911
State public health laboratory provides or assures testing for soil.
Measure Name

M911

Measure Source

Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m902
State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory).
Measure Name

M902

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)

Data date(s)

2016 & 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.

Score

Yes

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Community Planning & Engagement Coordination

cscc: cross sector community collaboration

arp: children other at risk populations

mvde: management of volunteers during emergencies

scc: social capital cohesion

This is best viewed on desktop.

The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.

6.7
Measure
Measure Description
Score
m87
State health department is accredited by the Public Health Accreditation Board (PHAB).
Measure Name

M87

Measure Source

Public Health Accreditation Board (PHAB), Health Departments in e-PHAB

Data date(s)

2013-2020

Limitations

The measure does not reflect health departments that are in process of achieving accreditation.

Score

No

m501
Percent of the state's population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems.
Measure Name

M501

Measure Source

National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.

Data date(s)

2012, 2014, 2016 & 2018

Limitations

Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.

Score

44.0%

m9031
Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9031

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

m9032
Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9032

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

82.9%

m9033
Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9033

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

67.7%

m9034
Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9034

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.

5.8
Measure
Measure Description
Score
m163
Number of pediatricians per 100,000 population under 18 years old in the state.
Measure Name

M163

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.

Score

88.5

m164
Number of obstetricians and gynecologists per 100,000 female population in the state.
Measure Name

M164

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.

Score

23.8

m170
Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers.
Measure Name

M170

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.

Score

97.0%

m53b
Percent of youth who missed one or more days of school in past month due to concerns about safety.
Measure Name

M53B

Measure Source

Youth Risk Behavior Survey

Data date(s)

2011, 2013, 2015, 2017 & 2019

Limitations

The measure is self-reported and does not distinguish reasons for safety concerns.

Score

7.1%

The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.

3.2
Measure
Measure Description
Score
m36
State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry.
Measure Name

M36

Measure Source

Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Data date(s)

2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.

Score

Foundational

m266
Percent of the state's population who live in a county with a Community Emergency Response Teams (CERT).
Measure Name

M266

Measure Source

Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016

Limitations

The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.

Score

76.4%

m346
Number of total Medical Reserve Corps members per 100,000 population in the state.
Measure Name

M346

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).

Score

107.8

m176
Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state.
Measure Name

M176

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.

Score

2.7

m179
Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state.
Measure Name

M179

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.

Score

30.3

m186
Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state.
Measure Name

M186

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.

Score

74.8

The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.

4.2
Measure
Measure Description
Score
m175
Percent of voting-eligible population in the state participating in the highest office election .
Measure Name

M175

Measure Source

United States Election Project, General Election Turnout Rates

Data date(s)

2012, 2014, 2016, 2018 & 2020

Limitations

The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).

Score

54.6%

m188
Percent of adults in the state who volunteer in their communities
Measure Name

M188

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.

Score

34.0%

m189
Number of annual volunteer hours per state resident, 15 years and older.
Measure Name

M189

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.

Score

33.5

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Incident & Information Management

incm: incident management

infm: information management

This is best viewed on desktop.

The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.

9.9
Measure
Measure Description
Score
m10
State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners.
Measure Name

M10

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2016

Limitations

The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.

Score

Foundational

m84
State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP).
Measure Name

M84

Measure Source

Emergency Management Accreditation Program (EMAP), Who Is Accredited?

Data date(s)

2014-2020

Limitations

The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.

Score

Yes

m107
Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii.
Measure Name

M107

Measure Source

National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments

Data date(s)

2013 & 2016

Limitations

The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.

Score

100.0%

m229
State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency.
Measure Name

M229

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.

Score

Foundational

m150
State uses a system for tracking hospital bed availability during emergencies.
Measure Name

M150

Measure Source

Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program

Data date(s)

2012-2018

Limitations

The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.

Score

Foundational

m701
Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty.
Measure Name

M701

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

44.0

m344
State has adopted or implemented the Nurse Licensure Compact (NLC).
Measure Name

M344

Measure Source

National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States

Data date(s)

2014-2020

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.

Score

Yes

m338
State requires health care facilities to report health care associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems.
Measure Name

M338

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report

Data date(s)

2012 & 2013

Limitations

The measure does not evaluate the health care facility compliance with reporting requirements.

Score

Foundational

m341
State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department.
Measure Name

M341

Measure Source

CDC Public Health Law Program resources. https://www.cdc.gov/phlp/

Data date(s)

2013

Limitations

The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.

Score

Foundational

m342
State law requires health care facilities to report communicable diseases to a health department.
Measure Name

M342

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013

Limitations

The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.

Score

Foundational

m345
State has adopted Emergency Management Assistance Compact (EMAC) legislation.
Measure Name

M345

Measure Source

National Emergency Management Association (NEMA)

Data date(s)

2014

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.

Score

Foundational

The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.

8.7
Measure
Measure Description
Score
m64
State has a public information and communication plan developed for a mass prophylaxis campaign.
Measure Name

M64

Measure Source

Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.

Data date(s)

2012-2018

Limitations

The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.

Score

Foundational

m228
Percent of households in the state with broadband in the home.
Measure Name

M228

Measure Source

American Community Survey (ACS), 1-year estimate (GCT2801).

Data date(s)

2012-2019

Limitations

The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.

Score

85.6%

m906
Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
Measure Name

M906

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

99.0%

m907
Percent of office-based medical doctors and doctors of osteopathy in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs.
Measure Name

M907

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

65.0%

m1001
The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure.
Measure Name

M1001

Measure Source

National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).

Data date(s)

2014-2019

Limitations

Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.

Score

Yes

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Health Care Delivery

pc: prehospital care

hps: hospital and physician services

ltc: long term care

mbh: mental behavioral health care

hc: home care

This is best viewed on desktop.

Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.

5.5
Measure
Measure Description
Score
m140
Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state.
Measure Name

M140

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

72.5

m331
Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state.
Measure Name

M331

Measure Source

National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information

Data date(s)

2015 & 2019

Limitations

The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.

Score

32.0%

m349
State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation.
Measure Name

M349

Measure Source

National Association of State EMS Officials

Data date(s)

2013-2018, 2020-2021

Limitations

Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.

Score

Yes

m350u
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas.
Measure Name

M350U

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

Data Missing

m350r
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas.
Measure Name

M350R

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

Data Missing

Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.

5.6
Measure
Measure Description
Score
m147
Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1).
Measure Name

M147

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2019

Limitations

The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.

Score

278.0

m148
Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2).
Measure Name

M148

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2020

Limitations

The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.

Score

93.0

m152
Percent of the state's population who live within 50 miles of a trauma center, including out-of-state centers.
Measure Name

M152

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.

Score

99.8%

m160
Number of physicians per 100,000 population in the state.
Measure Name

M160

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2011-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.

Score

84.9

m167
Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state.
Measure Name

M167

Measure Source

National Council of State Boards of Nursing (NCSBN), National Nursing Database

Data date(s)

2013-2016, 2018-2021

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.

Score

1,577.6

m168
Percent of the state's population living within 100 miles of a burn center, including out-of-state centers.
Measure Name

M168

Measure Source

American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.

Data date(s)

2014 & 2018

Limitations

The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.

Score

96.6%

m296
Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care).
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.

Score

41.5%

m297
Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program).
Measure Name

M297

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.

Score

41.5%

m298
Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states.
Measure Name

M298

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.

Score

40.2

m299
Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia.
Measure Name

M299

Measure Source

The Commonwealth Fund, Scorecard on State Health System Performance

Data date(s)

2011-2018

Limitations

Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.

Score

13.8%

m300
Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score.
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013-2020

Limitations

The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.

Score

55.9%

Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.

5.3
Measure
Measure Description
Score
m308
Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M308

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

0.7

m309
Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state.
Measure Name

M309

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

2.1

m307
Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine.
Measure Name

M307

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2013-2021

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

96.0%

m310
Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M310

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

1.1

m303b
Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (expressed as quintiles).
Measure Name

M303B

Measure Source

CMS Nursing Facility Inspection Reports

Data date(s)

2014-2020

Limitations

Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.

Score

4.0

m23nh
Number of disease outbreaks in nursing homes or assisted living facilities with a confirmed etiological agent (per 10,000 certified nursing home residents)
Measure Name

M23NH

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

States vary in their ability to detect and report outbreaks in long-term care settings.

Score

14.4

m880
Percentage of nursing home residents at facilities that did not have an infection control deficiency.
Measure Name

M880

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies

Data date(s)

2017-2020

Limitations

Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.

Score

64.2%

Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.

5.6
Measure
Measure Description
Score
m316
Percent of hospitals in the state providing psychiatric emergency services.
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.

Score

41.5%

m317
Percent of need met for mental health care in health professional shortage areas (HPSA) in the state.
Measure Name

M317

Measure Source

The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services

Data date(s)

2014, 2016-2020

Limitations

The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.

Score

42.6%

m800
Percent of the state's population not living in an HRSA Mental Health Professional Shortage Area.
Measure Name

M800

Measure Source

U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.

Data date(s)

2015-2020

Limitations

The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.

Score

72.5%

Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.

6.8
Measure
Measure Description
Score
m291
Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season.
Measure Name

M291

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

82.6%

m292
Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner.
Measure Name

M292

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality of the services provided including length of service delays.

Score

95.3%

m293
Number of home health and personal care aides per 1,000 population in the state aged 65 or older.
Measure Name

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)

Data date(s)

2012-2019

Limitations

The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.

Score

31.1

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Countermeasure Management

mmmdd: medical materiel management distribution dispensing

cue: countermeasure utilization effectiveness

This is best viewed on desktop.

The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.

3.6
Measure
Measure Description
Score
m60
State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements.
Measure Name

M60

Measure Source

CDC PHEP

Data date(s)

2012-2018

Limitations

The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.

Score

Foundational

m161
Number of Pharmacists per 100,000 population in the state.
Measure Name

M161

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

81.8

m270
Percent of hospitals in the state participating in a group purchasing arrangement.
Measure Name

M270

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.

Score

49.6%

The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.

7.5
Measure
Measure Description
Score
m24
Percent of children ages 19-35 months in the state receiving the recommended routine childhood combined 7-vaccine series (4:3:1:3*:3:1:4), which includes ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, the full series of Hib (≥3 or ≥4 doses, depending on product type), ≥3 doses of HepB, ≥1 dose of varicella vaccine, and ≥4 doses of PCV.
Measure Name

M24

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)

Data date(s)

2012-2019

Limitations

The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.

Score

78.4%

m32
Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination.
Measure Name

M32

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

71.4%

m33
Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination.
Measure Name

M33

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel.

Data date(s)

2012-2019

Limitations

The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.

Score

73.9%

m34
Percent of children aged 6 months to 4 years old in the state receiving a seasonal flu vaccination.
Measure Name

M34

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2012-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

84.6%

m35
Percent of adults aged 18 years and older in the state receiving a seasonal flu vaccination.
Measure Name

M35

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

50.6%

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Environmental & Occupational Health

fws: food water security

em: environmental monitoring

pei: physical environment and infrastructure

wr: workforce resiliency

This is best viewed on desktop.

The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.

9.6
Measure
Measure Description
Score
m275_dw
State public health laboratory provides or assures testing for drinking water.
Measure Name

M275_DW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

Yes

m275_pww
State public health laboratory provides or assures testing for private well water.
Measure Name

M275_PWW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_rec
State public health laboratory provides or assures testing for recreational water.
Measure Name

M275_REC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_sur
State public health laboratory provides or assures testing for surface water.
Measure Name

M275_SUR

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m275_wst
State public health laboratory provides or assu+M132res testing for waste water.
Measure Name

M275_WST

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m276
Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.
Measure Name

M276

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

100.0%

m195
Percentage of community water systems in a state that meet all applicable health-based standards.
Measure Name

M195

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

95.7%

m925
Percentage of community water systems in a state that meet all applicable non-health-based standards.
Measure Name

M925

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

87.1%

m23pc
Estimated total number of foodborne individual illness cases reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population).
Measure Name

M23PC

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

20.9

The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.

8.0
Measure
Measure Description
Score
m202
State public health laboratory provides or assures testing for air samples.
Measure Name

M202

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m257_aiha
State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA).
Measure Name

M257_AIHA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

No

m257_epa
State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA).
Measure Name

M257_EPA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m257_nelac
State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC).
Measure Name

M257_NELAC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m196
State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism.
Measure Name

M196

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Foundational

m272
Percent of 10 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds.
Measure Name

M272

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

90.0%

m273
State public health laboratory provides or assures testing for hazardous waste.
Measure Name

M273

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m274
State participates in the National Plant Diagnostic Network (NPDN).
Measure Name

M274

Measure Source

National Plant Diagnostic Network (NPDN), National Plant Diagnostic website

Data date(s)

2014

Limitations

The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.

Score

Foundational

m904
Number of environmental scientists and specialists (including health) per 100,000 population in the state.
Measure Name

M904

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041

Data date(s)

2012-2019

Limitations

The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

37.0

m23a
Number of disease outbreaks due to animal contact in a state where the etiological agent is confirm (per 1 million population).
Measure Name

M23A

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.

Score

0.0

Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.

6.5
Measure
Measure Description
Score
m922
Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor).
Measure Name

M922

Measure Source

U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures

Data date(s)

2012-2019

Limitations

The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.

Score

95.4%

m923
Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition.
Measure Name

M923

Measure Source

U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)

Data date(s)

2016, 2018 & 2019

Limitations

A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type.  Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states

Score

42.1%

m928
Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program.
Measure Name

M928

Measure Source

FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)

Data date(s)

2017-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP. 

Score

48.8%

m929
Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains.
Measure Name

M929

Measure Source

U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)

Data date(s)

2013-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP.  Also, many flood zone maps are outdated.

Score

48.9%

m334
State has a climate change adaptation plan.
Measure Name

M334

Measure Source

Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation

Data date(s)

2014-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.

Score

Yes

Actions taken to protect workers and emergency responders from health hazards while on the job.

5.0
Measure
Measure Description
Score
m530
Percent of employed workers in the state who used some type of paid time off (PTO) benefit.
Measure Name

M530

Measure Source

Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.

Data date(s)

2013-2020

Limitations

Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.

Score

57.8%

m531
Percent of employed population in the state engaging in some work from home by telecommuting.
Measure Name

M531

Measure Source

Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.

Data date(s)

2011-2013, 2015, 2017, 2019

Limitations

The measure data is estimated based on a survey of a sample of the general population.

Score

22.5%

m705
Percent of employed population (16 and older) in the state who work from home.
Measure Name

M705

Measure Source

American Community Survey (ACS), 1-year estimate (Table B08128)

Data date(s)

2012-2019

Limitations

The measure data does not include all individuals who can work at home on a "part-time" basis.

Score

5.6%

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Health Security Surveillance

phsei: health surveillance epidemiological investigation

bmlt: biological monitoring laboratory testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.

8.9
Measure
Measure Description
Score
m17
State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS).
Measure Name

M17

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.

Data date(s)

2012-2015

Limitations

The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.

Score

Foundational

m18
Number of epidemiologists per 100,000 population in the state, by quintile.
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction

Data date(s)

2012-2019

Limitations

The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

3.0

m19
State health department participates in the Epidemic Information Exchange (Epi-X) System.
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m20
State health department participates in the National Electronic Disease Surveillance System (NEDSS).
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013-2015

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

Score

Foundational

m22
State health department has a syndromic surveillance system that can report and exchange information.
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012, 2016, & 2019

Limitations

Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.

Score

Yes

m217
State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies.
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m220
State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory.
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m256
State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet).
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

m23
Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed.
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

68.2%

m289
State health department participates in a broad prevention collaborative addressing health care associated infections (HAIs).
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.

Score

Foundational

m290
State has a public health veterinarian.
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015, 2017-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.

Score

Yes

m265
State uses an Electronic Death Registration System (EDRS).
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014-2018, 2020-2021

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.

Score

Yes

m801
State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network.
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

Score

Foundational

The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.

9.6
Measure
Measure Description
Score
m1
Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise.
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2013

Limitations

The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.

Score

Foundational

m1314
State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA).
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results

Score

Yes

m208
State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service).
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m8
State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1).
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m9
State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines.
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m11
State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours.
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

Score

Yes

m12
State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory.
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.

Score

Yes

m211
Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella.
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

100.0%

m216
Percent of 15 to 21 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin-mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies. The 2018 CLSS survey added 6 more items (i.e., Ebola, Chikungunya, Zika, Lyme disease, Candida auris, and Mobilized colistin resistance (MCR 1)), increasing the total to 21 tests.
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

100.0%

m2
Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories.
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Laboratories may not undergo proficiency testing for all assay capabilities.

Score

100.0%

m3
Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.

Score

98.0%

m5
Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state's Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise.
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2013-2017

Limitations

The measure does not consider the public health laboratory's ability to process a large number of samples.

Score

100.0%

m7
Number of additional chemical agent detection methods-beyond the core methods-demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state.
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider all methods that the laboratory is capable of testing.

Score

4.0

m286
Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually.
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

6.0

m287
Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.

Score

100.0%

m288
Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state.
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.

Score

9.0

m911
State public health laboratory provides or assures testing for soil.
Measure Name

M911

Measure Source

Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m902
State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory).
Measure Name

M902

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)

Data date(s)

2016 & 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.

Score

Yes

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Community Planning & Engagement Coordination

cscc: cross sector community collaboration

arp: children other at risk populations

mvde: management of volunteers during emergencies

scc: social capital cohesion

This is best viewed on desktop.

The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, health care, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.

6.7
Measure
Measure Description
Score
m87
State health department is accredited by the Public Health Accreditation Board (PHAB).
Measure Name

M87

Measure Source

Public Health Accreditation Board (PHAB), Health Departments in e-PHAB

Data date(s)

2013-2020

Limitations

The measure does not reflect health departments that are in process of achieving accreditation.

Score

No

m501
Percent of the state's population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems.
Measure Name

M501

Measure Source

National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.

Data date(s)

2012, 2014, 2016 & 2018

Limitations

Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.

Score

44.0%

m9031
Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9031

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

m9032
Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9032

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

82.9%

m9033
Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9033

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

67.7%

m9034
Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Measure Name

M9034

Measure Source

Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services

Data date(s)

2013-2017

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.

Score

100.0%

Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.

5.3
Measure
Measure Description
Score
m163
Number of pediatricians per 100,000 population under 18 years old in the state.
Measure Name

M163

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pediatricians in the event of an emergency.

Score

85.8

m164
Number of obstetricians and gynecologists per 100,000 female population in the state.
Measure Name

M164

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2010, 2015-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.

Score

24.0

m170
Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers.
Measure Name

M170

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.

Score

97.0%

m53b
Percent of youth who missed one or more days of school in past month due to concerns about safety.
Measure Name

M53B

Measure Source

Youth Risk Behavior Survey

Data date(s)

2011, 2013, 2015, 2017 & 2019

Limitations

The measure is self-reported and does not distinguish reasons for safety concerns.

Score

8.6%

The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of health care, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance.

3.2
Measure
Measure Description
Score
m36
State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry.
Measure Name

M36

Measure Source

Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Data date(s)

2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.

Score

Foundational

m266
Percent of the state's population who live in a county with a Community Emergency Response Teams (CERT).
Measure Name

M266

Measure Source

Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016

Limitations

The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.

Score

76.4%

m346
Number of total Medical Reserve Corps members per 100,000 population in the state.
Measure Name

M346

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2012-2014, 2016-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).

Score

107.8

m176
Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state.
Measure Name

M176

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.

Score

2.7

m179
Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state.
Measure Name

M179

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.

Score

30.3

m186
Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state.
Measure Name

M186

Measure Source

Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.

Data date(s)

2015-2018

Limitations

The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.

Score

74.8

The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.

5.3
Measure
Measure Description
Score
m175
Percent of voting-eligible population in the state participating in the highest office election .
Measure Name

M175

Measure Source

United States Election Project, General Election Turnout Rates

Data date(s)

2012, 2014, 2016, 2018 & 2020

Limitations

The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).

Score

72.0%

m188
Percent of adults in the state who volunteer in their communities
Measure Name

M188

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.

Score

34.0%

m189
Number of annual volunteer hours per state resident, 15 years and older.
Measure Name

M189

Measure Source

Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.

Data date(s)

2012-2015, 2017

Limitations

Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.

Score

33.5

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Incident & Information Management

incm: incident management

infm: information management

This is best viewed on desktop.

The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.

9.9
Measure
Measure Description
Score
m10
State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners.
Measure Name

M10

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2016

Limitations

The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.

Score

Foundational

m84
State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP).
Measure Name

M84

Measure Source

Emergency Management Accreditation Program (EMAP), Who Is Accredited?

Data date(s)

2014-2020

Limitations

The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.

Score

Yes

m107
Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii.
Measure Name

M107

Measure Source

National Association of County and City Health Officials (NACCHO), National Profile of Local Health Departments

Data date(s)

2013 & 2016

Limitations

The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.

Score

100.0%

m229
State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency.
Measure Name

M229

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.

Score

Foundational

m150
State uses a system for tracking hospital bed availability during emergencies.
Measure Name

M150

Measure Source

Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program

Data date(s)

2012-2018

Limitations

The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.

Score

Foundational

m701
Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty.
Measure Name

M701

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

44.0

m344
State has adopted or implemented the Nurse Licensure Compact (NLC).
Measure Name

M344

Measure Source

National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States

Data date(s)

2014-2020

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.

Score

Yes

m338
State requires health care facilities to report health care associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems.
Measure Name

M338

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare-Associated Infections (HAI) Progress Report

Data date(s)

2012 & 2013

Limitations

The measure does not evaluate the health care facility compliance with reporting requirements.

Score

Foundational

m341
State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department.
Measure Name

M341

Measure Source

CDC Public Health Law Program resources. https://www.cdc.gov/phlp/

Data date(s)

2013

Limitations

The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.

Score

Foundational

m342
State law requires health care facilities to report communicable diseases to a health department.
Measure Name

M342

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013

Limitations

The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.

Score

Foundational

m345
State has adopted Emergency Management Assistance Compact (EMAC) legislation.
Measure Name

M345

Measure Source

National Emergency Management Association (NEMA)

Data date(s)

2014

Limitations

The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.

Score

Foundational

The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.

8.8
Measure
Measure Description
Score
m64
State has a public information and communication plan developed for a mass prophylaxis campaign.
Measure Name

M64

Measure Source

Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.

Data date(s)

2012-2018

Limitations

The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.

Score

Foundational

m228
Percent of households in the state with broadband in the home.
Measure Name

M228

Measure Source

American Community Survey (ACS), 1-year estimate (GCT2801).

Data date(s)

2012-2019

Limitations

The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.

Score

86.7%

m906
Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
Measure Name

M906

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

99.0%

m907
Percent of office-based medical doctors and doctors of osteopathy in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs.
Measure Name

M907

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013-2016

Limitations

The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.

Score

65.0%

m1001
The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure.
Measure Name

M1001

Measure Source

National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).

Data date(s)

2014-2019

Limitations

Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.

Score

Yes

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Health Care Delivery

pc: prehospital care

hps: hospital and physician services

ltc: long term care

mbh: mental behavioral health care

hc: home care

This is best viewed on desktop.

Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between health care facilities.

5.5
Measure
Measure Description
Score
m140
Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state.
Measure Name

M140

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

71.8

m331
Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state.
Measure Name

M331

Measure Source

National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information

Data date(s)

2015 & 2019

Limitations

The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.

Score

32.0%

m349
State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation.
Measure Name

M349

Measure Source

National Association of State EMS Officials

Data date(s)

2013-2018, 2020-2021

Limitations

Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.

Score

Yes

m350u
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas.
Measure Name

M350U

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

Data Missing

m350r
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas.
Measure Name

M350R

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015-2019

Limitations

Selected states fail to record response times for all fatal events.

Score

Data Missing

Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.

5.6
Measure
Measure Description
Score
m147
Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1).
Measure Name

M147

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2019

Limitations

The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.

Score

278.0

m148
Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2).
Measure Name

M148

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care-State

Data date(s)

2013-2020

Limitations

The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.

Score

85.0

m152
Percent of the state's population who live within 50 miles of a trauma center, including out-of-state centers.
Measure Name

M152

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.

Score

99.8%

m160
Number of physicians per 100,000 population in the state.
Measure Name

M160

Measure Source

U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)

Data date(s)

2011-2018

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available physicians and surgeons in the event of an emergency.

Score

83.7

m167
Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state.
Measure Name

M167

Measure Source

National Council of State Boards of Nursing (NCSBN), National Nursing Database

Data date(s)

2013-2016, 2018-2021

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.

Score

1,604.3

m168
Percent of the state's population living within 100 miles of a burn center, including out-of-state centers.
Measure Name

M168

Measure Source

American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.

Data date(s)

2014 & 2018

Limitations

The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.

Score

96.6%

m296
Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care).
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.

Score

41.5%

m297
Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program).
Measure Name

M297

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.

Score

41.5%

m298
Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states.
Measure Name

M298

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.

Score

40.2

m299
Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia.
Measure Name

M299

Measure Source

The Commonwealth Fund, Scorecard on State Health System Performance

Data date(s)

2011-2018

Limitations

Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.

Score

13.5%

m300
Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score.
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013-2020

Limitations

The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.

Score

52.9%

Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.

5.6
Measure
Measure Description
Score
m308
Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M308

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

0.7

m309
Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state.
Measure Name

M309

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

2.1

m307
Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine.
Measure Name

M307

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2013-2021

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

96.0%

m310
Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state.
Measure Name

M310

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014-2021

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

Score

1.1

m303b
Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (expressed as quintiles).
Measure Name

M303B

Measure Source

CMS Nursing Facility Inspection Reports

Data date(s)

2014-2020

Limitations

Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.

Score

3.0

m23nh
Number of disease outbreaks in nursing homes or assisted living facilities with a confirmed etiological agent (per 10,000 certified nursing home residents)
Measure Name

M23NH

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

States vary in their ability to detect and report outbreaks in long-term care settings.

Score

12.3

m880
Percentage of nursing home residents at facilities that did not have an infection control deficiency.
Measure Name

M880

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Compare, Health Deficiencies

Data date(s)

2017-2020

Limitations

Since this measure is dependent upon government health inspectors evaluating and citing nursing homes for failing to ensure that all workers follow infection prevention and control rules, a cited deficiency is a function of the availability and diligence of inspectors.

Score

54.0%

Mental and behavioral health care is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.

5.7
Measure
Measure Description
Score
m316
Percent of hospitals in the state providing psychiatric emergency services.
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.

Score

41.5%

m317
Percent of need met for mental health care in health professional shortage areas (HPSA) in the state.
Measure Name

M317

Measure Source

The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA) & Designated Health Professional Shortage Areas Statistics, Designated HPSA Quarterly Summary, U.S. Dept. of Health and Human Services

Data date(s)

2014, 2016-2020

Limitations

The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.

Score

46.4%

m800
Percent of the state's population not living in an HRSA Mental Health Professional Shortage Area.
Measure Name

M800

Measure Source

U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.

Data date(s)

2015-2020

Limitations

The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.

Score

72.5%

Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.

6.8
Measure
Measure Description
Score
m291
Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season.
Measure Name

M291

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

81.8%

m292
Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner.
Measure Name

M292

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality of the services provided including length of service delays.

Score

96.1%

m293
Number of home health and personal care aides per 1,000 population in the state aged 65 or older.
Measure Name

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)

Data date(s)

2012-2019

Limitations

The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.

Score

31.2

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Countermeasure Management

mmmdd: medical materiel management distribution dispensing

cue: countermeasure utilization effectiveness

This is best viewed on desktop.

The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.

4.0
Measure
Measure Description
Score
m60
State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements.
Measure Name

M60

Measure Source

CDC PHEP

Data date(s)

2012-2018

Limitations

The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.

Score

Foundational

m161
Number of Pharmacists per 100,000 population in the state.
Measure Name

M161

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012-2019

Limitations

The measure does not consider mutual aid plans that may be in place for health care facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

88.0

m270
Percent of hospitals in the state participating in a group purchasing arrangement.
Measure Name

M270

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012-2018

Limitations

Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.

Score

49.6%

The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.

7.7
Measure
Measure Description
Score
m24
Percent of children ages 19-35 months in the state receiving the recommended routine childhood combined 7-vaccine series (4:3:1:3*:3:1:4), which includes ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, the full series of Hib (≥3 or ≥4 doses, depending on product type), ≥3 doses of HepB, ≥1 dose of varicella vaccine, and ≥4 doses of PCV.
Measure Name

M24

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)

Data date(s)

2012-2019

Limitations

The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.

Score

75.0%

m32
Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination.
Measure Name

M32

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

73.5%

m33
Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination.
Measure Name

M33

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel.

Data date(s)

2012-2019

Limitations

The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.

Score

75.6%

m34
Percent of children aged 6 months to 4 years old in the state receiving a seasonal flu vaccination.
Measure Name

M34

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2012-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

81.9%

m35
Percent of adults aged 18 years and older in the state receiving a seasonal flu vaccination.
Measure Name

M35

Measure Source

Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report

Data date(s)

2013-2020

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on health care facilities may be marginal in the event of a major disaster.

Score

55.7%

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Environmental & Occupational Health

fws: food water security

em: environmental monitoring

pei: physical environment and infrastructure

wr: workforce resiliency

This is best viewed on desktop.

The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.

9.5
Measure
Measure Description
Score
m275_dw
State public health laboratory provides or assures testing for drinking water.
Measure Name

M275_DW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

Score

Yes

m275_pww
State public health laboratory provides or assures testing for private well water.
Measure Name

M275_PWW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_rec
State public health laboratory provides or assures testing for recreational water.
Measure Name

M275_REC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Yes

m275_sur
State public health laboratory provides or assures testing for surface water.
Measure Name

M275_SUR

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m275_wst
State public health laboratory provides or assu+M132res testing for waste water.
Measure Name

M275_WST

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m276
Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.
Measure Name

M276

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

100.0%

m195
Percentage of community water systems in a state that meet all applicable health-based standards.
Measure Name

M195

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

96.7%

m925
Percentage of community water systems in a state that meet all applicable non-health-based standards.
Measure Name

M925

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012-2019

Limitations

The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.

Score

85.9%

m23pc
Estimated total number of foodborne individual illness cases reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population).
Measure Name

M23PC

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

Score

47.1

The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends.

7.9
Measure
Measure Description
Score
m202
State public health laboratory provides or assures testing for air samples.
Measure Name

M202

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m257_aiha
State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA).
Measure Name

M257_AIHA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

No

m257_epa
State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA).
Measure Name

M257_EPA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m257_nelac
State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC).
Measure Name

M257_NELAC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

Score

Yes

m196
State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism.
Measure Name

M196

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

Foundational

m272
Percent of 10 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds.
Measure Name

M272

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

Score

90.0%

m273
State public health laboratory provides or assures testing for hazardous waste.
Measure Name

M273

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

Score

Yes

m274
State participates in the National Plant Diagnostic Network (NPDN).
Measure Name

M274

Measure Source

National Plant Diagnostic Network (NPDN), National Plant Diagnostic website

Data date(s)

2014

Limitations

The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.

Score

Foundational

m904
Number of environmental scientists and specialists (including health) per 100,000 population in the state.
Measure Name

M904

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041

Data date(s)

2012-2019

Limitations

The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

Score

38.3

m23a
Number of disease outbreaks due to animal contact in a state where the etiological agent is confirm (per 1 million population).
Measure Name

M23A

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.

Score

0.1

Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.

6.5
Measure
Measure Description
Score
m922
Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor).
Measure Name

M922

Measure Source

U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures

Data date(s)

2012-2019

Limitations

The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.

Score

95.6%

m923
Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition.
Measure Name

M923

Measure Source

U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)

Data date(s)

2016, 2018 & 2019

Limitations

A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type.  Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states

Score

42.1%

m928
Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program.
Measure Name

M928

Measure Source

FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)

Data date(s)

2017-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP. 

Score

48.8%

m929
Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains.
Measure Name

M929

Measure Source

U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)

Data date(s)

2013-2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP.  Also, many flood zone maps are outdated.

Score

48.9%

m334
State has a climate change adaptation plan.
Measure Name

M334

Measure Source

Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation

Data date(s)

2014-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.

Score

Yes

Actions taken to protect workers and emergency responders from health hazards while on the job.

5.2
Measure
Measure Description
Score
m530
Percent of employed workers in the state who used some type of paid time off (PTO) benefit.
Measure Name

M530

Measure Source

Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.

Data date(s)

2013-2020

Limitations

Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.

Score

57.0%

m531
Percent of employed population in the state engaging in some work from home by telecommuting.
Measure Name

M531

Measure Source

Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.

Data date(s)

2011-2013, 2015, 2017, 2019

Limitations

The measure data is estimated based on a survey of a sample of the general population.

Score

27.9%

m705
Percent of employed population (16 and older) in the state who work from home.
Measure Name

M705

Measure Source

American Community Survey (ACS), 1-year estimate (Table B08128)

Data date(s)

2012-2019

Limitations

The measure data does not include all individuals who can work at home on a "part-time" basis.

Score

5.8%

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