Flu on Call TM : Improving Access to Medical Care in a Severe Influenza Pandemic: Centers Play a Vital Role

Transcription

1 Flu on Call TM : Improving Access to Medical Care in a Severe Influenza Pandemic: Centers Play a Vital Role Lisa Koonin, DrPH, MN, MPH Centers for Disease Control June 3,

2 Potential Problems During a Severe Pandemic Large numbers of ill persons seek care EDs, clinics, and medical offices crowded Surge on medical facilities Delays seeing a provider Potential for delays in antiviral treatment 2

3 Preparing for a Severe Pandemic: Mitigating Medical Facility Surge Improve capacity of medical care systems AND Drive down transmission of disease and reduce unneeded visits 3

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5 A Mild to Moderate Pandemic 2009 H1N1 5

6 Even During Seasonal Flu January

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8 Minnesota Flu Line 2009 H1N1 Between Oct March 2010, the Minnesota Flu Line: Fielded more than 27,000 calls Averted an estimated 11,000 in person provider visits Source: Spaulding et al, Public Health Reports / Sept Oct 2012 / Volume 127 8

9 Results from MDH Nurse Triage Line Those that completed MDH Nurse Protocol Clinical Evaluation MDH Protocol N=5,949 Home Care Only Home Care AND Antiviral Indicated Call MD See MD Go to ED Call 911 2,292 (39%) 374 (6%) 497 (8%) 1,292 (22%) 3,659 (62%) were recommended to NOT seek in-person care 39% 6% 8% 22% 15% 875 (15%) Other 496 (8%) 123 (2%) Source: Ruth Lynfield 8% 2%

10 How Can We Build On Existing Systems? Poison Control Centers 211 info lines Health Plan NTLs Public Health Emergency NTLs COORDINATED RESPONSE Hospital NTLs Other NTLs Providers & Clinic NTLs 10

11 MAP 11

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13 Flu on Call Goals Explore the possibility of using a coordinated national network of triage lines during a severe pandemic to: Improve access to antiviral prescriptions for ill persons Provide an alternative to face to face provider encounters Reduce medical surge and increase appropriate use of medical resources 13

14 Core Flu on Call Project Partners 14

15 Flu on Call Assumptions for Planning Scope nationwide availability of services Some callers can be served by where they belong Only used in a severe pandemic when: Large proportion of people are experiencing ILI symptoms are seeking care and/or Medical systems not meeting the need People will need accurate and reliable information May be used for other public health emergencies This will work best if network is built, tested, and confirmed ready to activate 15

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17 DRAFT Call Flow for Flu on Call IVR * Caller dials a specific toll free number Caller enters his/her state to aid call routing Specialist NO Are you ill or caring for someone who is ill with ILI? YES Are you a member of a participating health plan/ system? Specialist Provides info directly Refers caller to public health information (hotline, website) or other community resources YES Specialist refers or transfers caller to other triage line NO Specialist transfers caller to a Poison Center *Interactive voice response

18 Flu on Call Exercise Purpose, Goal, and Objectives Purpose. To validate the capabilities of the UWW centers participating in Flu on Call during a severe pandemic. Goal. Exercise UWW call centers plans for participating in Flu on Call and identify future improvements to those plans Objectives. Determine effectiveness of telephony infrastructure to receive and route calls to centers. Confirm ability of centers to manage influenza information only calls and manage calls from persons who may be ill with influenza (transfer to poison centers and to other triage lines) while simultaneously responding to real world calls Test/exercise a just in time training plan developed for the use during a severe pandemic for centers. Test database usability and capacity for information specialists to locate relevant public health emergency information to provide to callers during a severe pandemic As of May 9,

19 May and June Exercises Participating Pilot Sites Poison Center location 2 1 1Call Center location As of May 9, 2014

20 Potential Benefits of Flu on Call Improve access to prescriptions for antiviral medications Direct ill persons to care, if needed Reduce unnecessary ED, clinic, and provider visits (minimize surge) Provide accurate information to the public (signs and symptoms of influenza, home care, medication information, when/where to seek medical care, outbreak information) Reduce transmission of infection in waiting room areas Reduce misinformation and rumors about pandemic 20

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22 Thank you! Lisa Koonin, DrPH, MN, MPH Senior Advisor Lead, Pandemic Influenza Medical Care and Countermeasures Task Force Influenza Coordination Unit U.S. Centers for Disease Control 22

23 June 2014 CDC Flu on Call Support during a pandemic United Way Worldwide/2-1-1 Engagement

24 Introduction United Way Worldwide unique relationship with network leveraging capabilities and capacity provides a single platform nationwide access for those in need. 24

25 2-1-1 Flu on Call Front Door Provides: 1. Consistent updated information pertaining to the pandemic, immunization centers, health related information and referral and basic call triaging. 2. Minimizing exposure for people who only need information 3. Accurate and real time information provided by DOH 4. Secondary information such as insurance options Conserves nurses/medical professional s time Provides timely population-based trend and surveillance data to inform outreach efforts and public health in their response. Realtime reporting and analysis Offers follow up or call back option thru voice/text 25

26 CDC Pilot Project Activities As a result of the successful simulations results, the CDC plans to further test and PCC capability to stand up a nurse triage flu helpline in times of a pandemic. September 2013 the CDC awarded UWW/211 to participate in round 2 of the Flu on Call Pilot in partnership with AAPCC 26 June 10, 2014

27 Roles and Responsibilities Project Manager Training Coordinator Database Resources Specialist 11 Team Leads (1 per center) 110 Specialists (11 per center) Ability to increase 250% if activated in a pandemic/crisis 27 June 10, 2014

28 Pilot sites selected 2 year agreement between UWW and 211 sites Site considerations: Current telephony platform, HHS regions, PCC support coverage and CDC guidance Single integrated telephony platform and database Flat Grant awarded to each for participation and deliverables 2 simulations each year specific Joint and PCC Separate agreement issued if 2-1-1/PCC helpline is activated for a pandemic or emergency 28 June 10, 2014

29 Participating sites NJ Partnership WIN Virginia Los Angeles United Way of Northeast Louisiana United Way Association of South Carolina Cleveland Texas Palm Beach/Treasure Coast Mile High United Way (Denver, CO) * Atlanta 29 June 10, 2014

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31 Flu on Call Support

32 Site Readiness Standardize Telephony incontact Requirements and connectivity testing IVR and Speech Recognition software Single customized database Visionlink AAPCC joint database and CRM ASTHO, NACCHO, CDC, National I&R data On-site and webinar training Surge plan documentation Mock simulations March and May Network 32 June 10, 2014

33 May 20 th CDC Simulation Results 32 actors in Atlanta Over 500 calls received in 3 hours 90% Service Level 240 of the 500 calls triaged and transferred to 911 VA Health Insurance Providers Poison Control Centers exceed expectation 33 June 10, 2014

34 Preliminary Data Outcome from Exercise 206 Flu FAQ 187 Poison Ctrl Xfer 50 MCO Xfer 20 Non-med I&R 19 VA Xfer referral 7 Wrong number 520 handled contacts 272 transfers AHT 5.23 minutes/att 3.53 minutes ACW (disposition) time of 1.70 minutes 34 June 10, 2014

35 Next Steps Preparation for June 27 th Simulation and PCC Joint Establish a joint command center for UWW/211 and PCC Preparation to increase participation by 5 centers 35 June 10, 2014

36 UWW Surge Conceptual Response Plan Warm Centers Phase 1 Other Centers Volunteers and UW and Resources UWW External Partners Phase 4 36 June 10, 2014

37 Contact Lisa Austin Director, UWW Enhancements United Way Worldwide 701 N Fairfax St Alexandria VA x Lisa.Austin@uww.unitedway.org 37

38 Thank you