Application of a return of investment analysis for public health training by case study.

BACKGROUND: Local health departments require assurance of competence of their workforce to prevent and mitigate outbreaks by supporting the implementation of evidence-based actions in clinical practice, medical procedures and infection control practices. Too often outdated policies or reduction in budgets prevent the appropriate training strategies or resources to recruit, retain or support this capability. DESIGN AND METHODS: In this 2018 case study analysis, we coupled the Phillip's Return on Investment model with a standard financial proforma model to make a business case that investing in training, specifically the Certification in Infection Control (CIC), was worthwhile for cost reduction, improved knowledge, skills and abilities (KSA's) and improved employee retention. RESULTS: Our model demonstrated that our initial investment (USD $1,840) was profitable based on the internal rate of return (IRR = 130%, Year. 5), payback period (0.71 years), Benefit Cost Ratio (BCR = 1.41) and Return of Investment (ROI = 41%), if an epidemiologist worked a minimum of 3 healthcare associated infection outbreaks per year. Data from 4 local epidemiologists demonstrated that the application of KSA's reduced investigation hours by 10%-25% for all types of outbreaks with payback periods of less than 6 months and positive ROIs for staff with retention greater than 1 year. Our model demonstrated that at the highest end of our investment costs (US $2940) with an investigation improve efficiency of 25%, the IRR was 85% after year 5 with a payback period of 1.13 years if the epidemiologist worked on 3 HAI outbreaks per year over the 5 years. CONCLUSIONS: Our results validate the profitability of investment into the CIC for local epidemiologists if they could be retained longer than the payback period. The model provides a method for managers to leverage training opportunities for employee retention while ensuring competencies in the workforce.

Social Network Analysis of Patient Movement Across Health Care Entities in Orange County, Florida.

OBJECTIVE: Multidrug-resistant organisms (MDROs) are continually emerging and threatening health care systems. Little attention has been paid to the effect of patient transfers on MDRO dissemination among health care entities in health care systems. In this study, the Florida Department of Health in Orange County (DOH-Orange) developed a baseline social network analysis of patient movement across health care entities in Orange County, Florida, and regionally, within 6 surrounding counties in Central Florida. MATERIALS AND METHODS: DOH-Orange constructed 2 directed network sociograms-graphic visualizations that show the direction of relationships (ie, county and regional)-by using 2016 health insurance data from the Centers for Medicare & Medicaid Services, which include metrics that could be useful for local public health interventions, such as MDRO outbreaks. RESULTS: We found that both our county and regional networks were sparse and centralized. The county-level network showed that acute-care hospitals had the highest influence on controlling the flow of patients between health care entities that would otherwise not be connected. The regional-level network showed that post-acute-care hospitals and other facilities (behavioral hospitals and mental health/substance abuse facilities) served as the primary controls for flow of patients between health care entities. The most prominent health care entities in both networks were the same 2 acute-care hospitals. PRACTICE IMPLICATIONS: Social network analysis can help local public health officials respond to MDRO outbreak investigations by determining which health care facilities are the main contributors of dissemination of MDROs or are at high risk of receiving patients with MDROs. This information can help epidemiologists prioritize prevention efforts and develop county- or regional-specific interventions to control and halt MDRO transmission across a health care network.

Local Public Health Surveillance of Heroin-Related Morbidity and Mortality, Orange County, Florida, 2010-2014.

OBJECTIVES: Heroin-related deaths have increased substantially in the past 10 years in the United States, particularly in Florida. Our objectives were to measure heroin-related morbidity and mortality rates in Orange County, Florida, and to assess trends in those rates during 2010-2014. METHODS: We used 3 heroin surveillance methods, based on data from the Florida Medical Examiner, the Florida Agency for Health Care Administration (AHCA), and the Electronic Surveillance System for the Early Notification of Community-Based Epidemics-Florida (ESSENCE-FL). We conducted descriptive and geographic spatial analyses of all 3 data sets, determined heroin-related mortality and morbidity (emergency department [ED] visit) rates, and compared the timeliness of data availability from the 3 data sources. RESULTS: Heroin-related deaths in Orange County increased by 590%, from 10 in 2010 to 69 in 2014. Heroin-related ED visits during the same period increased 12-fold (from 13 to 154) and 6-fold (from 49 to 307) when based on AHCA and ESSENCE-FL data, respectively. ESSENCE-FL identified 140% more heroin-related visits than did AHCA. Spatial analysis found geographic clustering of heroin-related morbidity and mortality. Hospitals facing the greatest burden of heroin-related ED visits were close to communities with the highest crude heroin-related ED visit rates. Of the 3 data sources, ESSENCE-FL provided the timeliest data availability. CONCLUSIONS: These 3 data sources can be considered acceptable surveillance systems for monitoring heroin-related events in Orange County. The timely availability of data from ESSENCE-FL makes it the most useful source for obtaining near-real-time data about the heroin epidemic, potentially leading to improved identification of populations most in need of interventions to reduce morbidity and mortality.

Use of Surveillance Systems in Detection of a Ciguatera Fish Poisoning Outbreak - Orange County, Florida, 2014.

What is already known on this topic? Ciguatera fish poisoning (CFP), caused by the ingestion of predatory reef-dwelling fish harboring ciguatoxins is one of the most commonly reported fish-associated marine intoxications. Ciguatoxin retains toxicity regardless of freezing or cooking. Prompt treatment can reduce debilitating neurologic symptoms that are associated with CFP.What is added by this report? Syndromic surveillance systems in Florida identified six adults with CFP following consumption of black grouper. Five patients sought medical attention; health care providers did not make a diagnosis of CFP or report the cases to public health authorities, and none of the patients received treatment. Close collaboration among several investigating agencies allowed traceback efforts to link black grouper consumed by all patients to a common international distributor.What are the implications for public health practice? Syndromic surveillance systems capable of detecting CFP are essential public health tools to identify outbreaks and enhance investigations. Medical and public health practitioners should be educated to inquire about recent fish consumption when evaluating patients with clinically compatible signs and symptoms to allow for prompt treatment, and report suspected CFP cases to public health authorities to facilitate source-food traceback efforts. Public education on avoidance of consumption of relatively large predatory reef fish species known to be from ciguatoxic-endemic areas might reduce the risk for CFP.