Project 2.  Linking Assessment and Measurement to PHEP through Engineering Systems Analysis (Finkelstein & Larson (MIT)) will focus on in the second step of the LAMPS measurement development cycle: identifying preparedness domains and criteria.  Adopting an engineering systems approach, the project will explore how public health systems can help to create an environment and shared knowledge base that will mitigate the deleterious health-related consequences of sudden disasters of all types.  The initial focus will be on non-pharmaceutical interventions (NPIs) which can reduce the transmission rate and the severity of infectious diseases such as pandemic influenza in the community.  For example, for a threat such as pandemic influenza, a host of interventions ranging from broad social distancing measures (such as school closings) to individual interventions (such as hand-washing) have been suggested and debated.  While preliminary epidemiologic data exist supporting the theoretical efficacy of such interventions, little is known about their relative efficacy in controlling an outbreak and mitigating the consequences.

Three specific aims are considered:

1.   The first aim seeks to determine the necessary public health systems capabilities needed to implement these strategies-the domains of PHEP - that must be measured to monitor a public health system's level of preparedness.  To answer this question we will use a modeling approach to identify the most effective NPIs that a public health system can use to control a pandemic influenza outbreak and mitigate its consequences.  We expect to find that:

2.  What levels of the capabilities identified in Aim 1 - the PHEP criteria - are necessary to ensure preparedness?  To answer this question we will use a modeling approach to identify how extensively, and how rapidly, a public health system is able to implement the NPIs identified as promising in Aim 1 to control a pandemic influenza outbreak and mitigate its consequences. 

3.  Are macro and micro measures similarly effective for other hazards that challenge public health systems, including earthquakes, floods, hurricanes, conflagrations, tornadoes, industrial explosions, terrorist attacks as well as natural and intentional infectious disease outbreaks?  We expect that a variety of macro and micro measures will be as important as health systems measures for most other hazards that challenge public health systems.

Principal Investigator for Project 2:
Stan N. Finkelstein, MD will serve as Lead Investigator for Project 2.  Dr. Finkelstein is a Senior Research Scientist at the MIT Engineering Systems Division and the Harvard-MIT Division of Health Sciences and Technology, and Senior Lecturer in the HMS Department of Health Care Policy.  A specialist at the interface of medicine and health care management, he has worked actively since 1975 with a multidisciplinary team of research colleagues at MIT and HMS focusing on policy issues related to the effectiveness of medical and public health practice and technology.  An active consultant to U.S. and international pharmaceutical, biotechnology, and medical device firms, as well as to health services organizations and government agencies, Dr. Finkelstein is an expert in outcomes research.  His earlier work in PHEP includes a systems-model-based cost/outcome analysis of immunization strategies for pandemic influenza.   

Co-Investigators:
Richard Larson, PhD will serve as Co-Investigator for Project 2. Dr. Larson is MIT's Mitsui Professor in the Department of Civil and Environmental Engineering and in the Engineering Systems Division and also founding Director of the Center for Engineering System Fundamentals.  He has widely published in the fields of operations research, emergency response systems, queuing, logistics, disaster management, and disease dynamics.  He was a member of the IOM Committee that produced the 2008 IOM Letter Report on Preparedness¹ and will soon be joining the IOM Board on Health Sciences Policy.  Dr. Larson serves as PI of a Sloan Foundation grant (see Section 4.3.3.1) regarding engineering systems research on PHEP in the context of pandemic influenza.

Michael A. Stoto, PhD will serve as the Co-Investigator for Project 2.  Dr. Stoto is one of the leading PHEP performance measurement experts in the country, Dr. Stoto is currently an Adjunct Professor of Biostatistics at HSPH, Director of the Evaluation Core of the HSPH CPHP, and Professor of Health Systems Administration and Population Health at Georgetown University.  He currently leads the evaluation team for the DC Healthcare Coalition Emergency Management Partnership, funded by the DHHS Office of the Assistant Secretary for Preparedness and Response (ASPR), and recently completed a multi-site project investigating regional approaches to PHEP funded by the Robert Wood Johnson Foundations Public Health Systems Research initiative.
 

Contact Information:
Engineering Systems Division
Massachusetts Institute of Technology
One Amherst Street, E40-2nd Floor
Cambridge, MA  02139-4307
USA

Alison Hearn
Assistant to Richard C. Larson, Ph.D.
Email: hearn@mit.edu
Telephone: (617) 324-0377
Fax:  (617) 258-7733
 
Joanne McHugh
Assistant to Stan N. Finkelstein, M.D.
Email: jamchugh@MIT.EDU
Telephone: (617) 253-0586