The Standardization Subcommittee of the Metro Atlanta Surveillance Team

State: GA Type: Model Practice Year: 2005

The Metro Atlanta Surveillance Task Force originated as a result of the 1999 West Nile virus outbreak in the Northeast, which caused public health officials in Atlanta to recognize the potential for the disease to spread to Georgia. Atlanta's size (3.5 million residents) and number of political jurisdictions (10 counties each with a board of health) meant developing a coordinated response plan would be a challenging task.To address these issues, in early 2000, staff from the five health districts in the metro Atlanta area and the state health department voluntarily convened the Metropolitan Atlanta Surveillance Task Force (MASTF) to create a regional approach to this emerging infection. MASTF developed a plan for public education, environmental monitoring, and disease surveillance. Once the West Nile Virus Plan was adopted, MASTF members felt the task force's collaborative activities could be applicable to other established and emerging health threats. As a result of discussion at a MASTF strategic planning retreat held mid-2002, MASTF members addressed a need to respond to infectious diseases and similar threats in a coordinated manner. Thus the Standardization Subcommittee was formed in 2003. This group is comprised of epidemiology staff representing the Georgia Division of Public Health (GDPH), five core metropolitan Atlanta district public health offices, and one epidemiologist from a district health office outside of Atlanta. The goal of the Standardization Subcommittee is to collaborate across districts to respond to the needs of metro Atlanta's population in an efficient and timely manner. In order to accomplish this goal, the subcommittee members wanted to develop standardized protocols for managing infectious diseases and other health threats. The intent is to have scientifically sound, evidence-based protocols that are consistent throughout the metropolitan Atlanta area. This is particularly important due to the fact that most district investigations cross jurisdictional boundaries.
Metropolitan Atlanta is comprised of five health districts, ten counties, and a number of geopolitical jurisdictions. Residents typically live, work, and play across these jurisdictions, blurring the lines of responsibility for those charged with protecting their health. To further complicate this issue, it is not unusual for metro Atlanta residents to seek primary care at a facility in a jurisdiction other than where they live. All of these factors add up to a defined need for communication, collaboration, and consistency of investigation among public health officials in these affected health districts. During a MASTF strategic planning retreat held in June 2002, a suggestion was made to form a subcommittee that could collectively address this need. The rationale was that all health districts are affected by infectious diseases and other emerging health threats, and each health district has the same responsibility to respond to the health needs of its residents in an efficient and timely manner. In the latter half of 2002, each health district was individually crafting its own Smallpox Investigation Protocols. Instead of creating six different, individual plans, district health staff agreed to operationalize the MASTF retreat recommendations; the first Standardization subcommittee meeting was held in March 2003. Using the Centers for Disease Control and Prevention's (CDC) Smallpox Response Plan template, the subcommittee collaborated for several months to craft a metro-wide Smallpox Investigation Protocol. The document was made available in an electronic format so that each district could tailor the plan with its own district specific information. The document was posted on the State's web-based training resource (G-TRAIN) so that all districts throughout Georgia could access the document.
Agency Community RolesOnce the protocols are drafted, they are presented to the entire MASTF membership for approval. MASTF consists of local and state epidemiologists, Environmental Health Specialists, nurses, Public Information Officers and our partners in academia and other government agencies, such as the Georgia Environmental Protection Division (EPD). After MASTF has approved a protocol, it is forwarded to the District Health Directors for final approval. Once the District Health Directors review and approve the protocol, it is distributed to all of the metro districts and posted on G-TRAIN for access statewide.  Costs and ExpendituresThe Standardization Subcommittee operates entirely as a voluntary entity. Each member's participation is supported by their respective District Health Director; meeting space and printing costs are in-kind contributions shared equally among the districts. GDPH contributes to the cost of managing the MASTF web site.  ImplementationThe Standardization subcommittee is comprised of epidemiologists, nurses, and physicians. The subcommittee elects a chairperson to facilitate the meetings. The group meets once a month following the larger MASTF meeting. Protocols to be developed are decided upon by the Subcommittee with recommendations taken from the entire MASTF group. After a topic is selected by consensus, a specific member of the Subcommittee is chosen to champion the protocol. This person creates a rough draft of the protocol, which is presented to the group at subsequent meetings for review and revision as needed. Once the investigation process for the selected topic is mapped out, the group can work to identify gaps in knowledge, opportunities for streamlining the process, and clearly defined roles and responsibilities of all parties involved. In order to assure that the protocols are developed using evidence-based practices, the group researches the current literature and contributes lessons learned from recent investigations. In addition, a representative from GDPH with specific expertise in the topic under review is invited to participate in the process. The timeline under which each protocol is developed may vary by complexity of the topic. The subcommittee works diligently to complete each protocol in a timely manner; completion time ranges from three months to six months per protocol.
The protocols developed by the Standardization Subcommittee represent, in effect, a policy change in the way infectious diseases and other health threats are managed at the district level. With the approval of each protocol by the metro District Health Directors, each of the districts has effectively "agreed to agree" on procedures for addressing infectious diseases within the metro Atlanta area. In addition, members of the Standardization Subcommittee have learned a great deal about specific infectious disease issues, thereby themselves becoming better public health practitioners. Participants of the subcommittee, as well as others with whom these protocols are shared, are now better able to serve the residents of their respective health districts. Each member has at his or her disposal a resource library of standardized protocols based on scientifically sound, evidence-based practices. This is a considerable improvement on the previous culture of purely individualized (and often unredeemed) response to infectious diseases and other health threats. All in all, the MASTF Standardization Subcommittee has and will continue to achieve its goal of efficient and timely response to infectious diseases and other health threats, in a manner that is coordinated and consistent across metro Atlanta region.
The value of the product, as well as the process itself, perpetuates the future work of the Subcommittee. Each member comes away from the table with an evidence-based protocol that may be used in everyday practice. The Subcommittee has already completed protocols for smallpox, meningitis, measles, and pertussis. In addition, at the request of a District Health Director, the group has developed a protocol entitled "Infectious Disease Case Management Across Jurisdictions" which outlines responsibility of public health investigations that involve multiple health districts. Future topics are decided upon by the group depending upon the incidence of a particular disease in the metro Atlanta area and complexity of the follow-up investigation required.