Savoia Elena, Lin Leesa, Bernard Dottie, Klein Noah, James Lyndon P, Guicciardi Stefano
Elena Savoia, Leesa Lin, Dottie Bernard, Noah Klein, Lyndon P. James, and Stefano Guicciardi are with the Emergency Preparedness Research, Evaluation & Practice (EPREP) Program, Division of Policy Translation & Leadership Development, Harvard T. H. Chan School of Public Health, Boston, MA.
Am J Public Health. 2017 Sep;107(S2):e1-e6. doi: 10.2105/AJPH.2017.304051.
In 2008, the Institute of Medicine released a letter report identifying 4 research priority areas for public health emergency preparedness in public health system research: (1) enhancing the usefulness of training, (2) improving timely emergency communications, (3) creating and maintaining sustainable response systems, and (4) generating effectiveness criteria and metrics.
To (1) identify and characterize public health system research in public health emergency preparedness produced in the United States from 2009 to 2015, (2) synthesize research findings and assess the level of confidence in these findings, and (3) describe the evolution of knowledge production in public health emergency preparedness system research. Search Methods and Selection Criteria. We reviewed and included the titles and abstracts of 1584 articles derived from MEDLINE, EMBASE, and gray literature databases that focused on the organizational or financial aspects of public health emergency preparedness activities and were grounded on empirical studies.
We included 156 articles. We appraised the quality of the studies according to the study design. We identified themes during article analysis and summarized overall findings by theme. We determined level of confidence in the findings with the GRADE-CERQual tool.
Thirty-one studies provided evidence on how to enhance the usefulness of training. Results demonstrated the utility of drills and exercises to enhance decision-making capabilities and coordination across organizations, the benefit of cross-sector partnerships for successfully implementing training activities, and the value of integrating evaluation methods to support training improvement efforts. Thirty-six studies provided evidence on how to improve timely communications. Results supported the use of communication strategies that address differences in access to information, knowledge, attitudes, and practices across segments of the population as well as evidence on specific communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents.
In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications: The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts.
2008年，医学研究所发布了一份信函报告，确定了公共卫生系统研究中公共卫生应急准备的4个研究重点领域：（1）提高培训的实用性；（2）改善应急通信的及时性；（3）创建并维持可持续的应对系统；（4）制定有效性标准和指标。
（1）识别并描述2009年至2015年美国开展的公共卫生应急准备方面的公共卫生系统研究；（2）综合研究结果并评估对这些结果的置信度；（3）描述公共卫生应急准备系统研究中知识产出的演变。检索方法和选择标准。我们查阅并纳入了1584篇来自MEDLINE、EMBASE和灰色文献数据库的文章的标题和摘要，这些文章聚焦于公共卫生应急准备活动的组织或财务方面，并基于实证研究。
我们纳入了156篇文章。我们根据研究设计评估研究质量。我们在文章分析过程中识别主题，并按主题总结总体结果。我们使用GRADE-CERQual工具确定结果的置信度。
31项研究提供了关于如何提高培训实用性的证据。结果表明演练对于提高决策能力和组织间协调的效用、跨部门伙伴关系对成功开展培训活动的益处，以及整合评估方法对支持培训改进工作的价值。36项研究提供了关于如何改善及时通信的证据。结果支持使用针对人群不同部分在信息获取、知识、态度和行为方面差异的通信策略，以及关于公共卫生和医疗保健人员所经历的特定通信障碍的证据。48项研究提供了关于如何创建并维持准备系统的证据。结果包括如何在组织和公民之间建立社会资本，以及如何开展维持灵活性并依赖现有医疗数据的可持续且有用的规划工作。26项研究提供了关于测量工作（如社区和组织需求评估）的有用性以及从对重大事件的应对中学习的新方法的证据。
在美国，自2008年医学研究所信函报告发布以来，公共卫生应急准备系统研究领域得到了美国疾病控制与预防中心的支持。公共卫生应急准备的首个定义出现在2007年，在2008年之前，医学研究所确定的所有4个研究领域都缺乏研究和实证证据。与公共卫生的其他研究领域相比，这个领域可被视为相对较新；例如，烟草控制研究可以依靠70多年的知识产出。然而，本综述表明，在过去7年中，公共卫生应急准备系统研究已从一般性探究发展为对特定干预措施的分析，且实证研究更多。对公共卫生的影响：本综述结果为负责加强准备和应对关键组成部分（如通信、培训和规划工作）的公共卫生从业人员提供了证据基础。
