Transcript Slide 1

Susan K. Laird, MSN, RN
Clinical Director/Content Lead
CDC-INFO
Presentation to
AIRS CONFERENCE
Reno, Nevada, June 1, 2009
1
Objectives
• The purpose of this workshop is to…
• Share CDC-INFO background, successes
and challenges, and lessons learned.
• Identify CDC and CDC-INFO resources
that are available for use every day and in
emergency response.
2
Agenda
• Welcome and Introductions
• What is CDC-INFO?
• Background and Scope
• Role in Emergency Response
• Impact – Internal and External
• Questions/Discussion
3
What Is CDC-INFO?
4
CDC-INFO Vision
To be a trusted source
that partners,
providers, and the
public come to for
accurate, timely and
consistent information.
5
What is CDC-INFO?
• Launched in 2005
• CDC-INFO employs 94 staff at its National Contact
Center
• Delivers health information 24/7/365
• Audience: Consumers, healthcare providers and
professionals
• English and Spanish service
CDC-INFO workload:
• More than 2.1 million telephone inquiries answered
since 2005
• Over 200,000 e-mails answered since 2005
• Distributes 9M publications annually
6
CDC-INFO Call and Email Counts
FY05
(Feb-Sep 05)
FY06
FY07
FY08
FY09
(Oct 08Apr 09)
Phone Calls
answered
325,820
496,580
377,015
372,969
309,035
Email
Requests
answered
4,496
33,067
41,171
49,305
55,979
Publications
Shipped
N/A
N/A
3,210,942*
8,887,097
4,252,472
CDC-INFO’s Role in Public Health
and Communication
•
•
Best Practices in eHealth Science and Research
Health Communication and Marketing
•
•
•
Multi-channel modalities to address differing informationseeking needs, preferences and behaviors
Audience Research: analyzing inquirers and
demographics to inform CDC programs
Public Health
•
Accurate, credible health information to positively impact
health behavior
•
•
•
•
“call to action”
Measure inquirers’ reported behavior change
Health Disparities and Health Equity
Emergency Response
8
CDC-INFO Structure and Scope
Contact Center
(Vangent– 2 locations)
Program
Leadership and
Coordination
Emergency
Response
• Calls, email, and TTY
• Three levels of expertise to address
audience needs:
> Tiers 1, 2, 3, Correspondence
• Maintains and refines content database with
CDC program approval
• Ongoing independent, systematic,
and continuous evaluation of the
Contact Center and the Fulfillment
contracts
• Call monitoring, program
calibration, customer satisfaction
surveys, follow up surveys,
special event surveys, and
emergency surveys.
• Technology and processes allow
CDC-INFO operations to handle call
volume increases from media
events, large campaigns, health
related emergencies, pandemics, or
bio-terrorist activities.
• Based on activation triggers and
coordination with ECS
• Turnkey publication warehouse
and fulfillment operation
Publication
Ordering
/Fulfillment
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Evaluation
EMT
Contact Center Operations
Contact Center
Management
2 Locations
Some remote staff
Location
Phoenix, AZ1
Supervision
Supervision
Tiers 1, 2, 3,
Tiers 1, 2, 3
Correspondence
Correspondence
Location
Rockville 2
Tier 33 Only
Only
Tier
Quality Assurance
Phone & Email
Contact Center
Operations
Vangent Staffing (Dec. 2008)
• Contact Center Operations
Management and Support - 8
• Phoenix and Rockville CSRs – 60
• Email Support- 13
• Content Development (SRA)- 9
• Training – 3
• Quality Assurance - 1
All calls recorded
1 in 25 calls per
Operator 3 rd party
evaluation
Training
Continuous:
Group &
Self-paced
Everything we do should help the contact center staff better meet the needs of consumers, providers and CDC partners
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Contact Center Tiers
Tier 1 (general):
Prepared responses, clinic referrals, and publication orders
Tier 2 (research):
Requests requiring web and database research
Tier 3 (provider):
Calls requiring medical/public health expertise and escalate inquiries to CDC
Correspondence (email)
Emails from physicians, public health partners, and general public
Interactive Voice Response (IVR) system
Tier 1 – 20,819 calls
Tier 2 – 7,436
calls
Tier 3 –
4,092 calls
Call Counts are for calls answered by Tier, December, 2008
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Content Development
• Prepared Responses are program cleared content
written in a question and answer format for contact
center reps to consistently and accurately answer
inquiries
• Over 8,000 Prepared Responses (PRs) in database
• Developed and cleared in collaboration with CDC
SMEs
• Plain language and scientific accuracy focus
• Focus on most frequently requested questions from
public and professional audiences
• Leverage existing CDC website content
• Maintains scientific integrity
• Meets Health Literacy and Plain Language goals
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Content Development
What the public wants to know…
•
•
•
•
•
What is it?
What are the signs/symptoms? (What does it look
like/feel like?)
How will it hurt me – will I die? How sick, etc.
How can I catch it/prevent myself (and my family,
loved ones, etc.) from catching it?
If I get it what should I do? Do I stay home and drink
fluids? See a doctor? Go to the ER? Call 911?
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Content Development
• What does CDC-INFO need to know
to best represent CDC Programs?
• What types of questions can we anticipate
from healthcare providers/hospitals?
• What types of questions can we anticipate
from state and local health departments?
14
Content Development
• What do you consider to be sentinel topics?
• Best to develop individual Prepared Responses for all
potential sentinel topics
• What constitutes an “event?”
• Do you have pre-defined “talking points” for events?
• Do you have “tipping points” defined?
• Is there a specific number of inquiries that could indicate an
event of some kind?
• When and how do you decide to ramp up?
15
Prepared Response Example
1053 - What is a healthcare provider's risk of HIV infection after occupational exposure?
The risk of a healthcare provider getting HIV after coming into contact with HIV-infected blood, through a needlestick or
cut, is very low (0.3 percent or about 3 chances out of 1,000). In fact, most injuries from needlesticks or cuts (99.7
percent) do not lead to infection.
The risk of a healthcare provider getting HIV after his or her:
* eye,
* nose, or
* mouth comes into contact with HIV-infected blood is also very low (0.1 percent).
The risk is also very low for a healthcare provider whose non-intact skin, such as a cut or scrape, comes into contact with
HIV-infected blood (less than 0.1 percent).
If you are a healthcare provider managing occupational exposures to blood/body fluids and have questions about
appropriate medical treatment after an exposure at work, you can call the National Clinicians' Post-Exposure Prophylaxis
Hotline (PEPline) at 1-888-448-4911 for guidance.
Call to Action
If you are a healthcare provider, and are concerned about contact you have had with blood or other body fluids, report it to
your supervisor right away. It is important to report the exposure to the right people in your workplace right away, because
you may need post-exposure treatment. If you do, it must be started as soon as possible.
PROBE:
Would you like to know what you should do if you are exposed to the blood of a patient?
See prepared response ID 1052, What should I do if I am exposed to the blood of a patient?
PROBE:
Would you like to know how effective postexposure prophylaxis (PEP) is in preventing percutaneous transmission in
healthcare personnel?
See prepared response ID 1408, Is postexposure prophylaxis (PEP) effective in preventing percutaneous transmission in
healthcare personnel?
[Partial example – there are publications and background materials on the full PR
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Evaluation
• Impact and Process Evaluation
• Quality Assurance
• Customer Satisfaction
• Audience Research
• User profiles
• Health disparities and health equity
• Methodology
• Approved OMB package for evaluation surveys,
including emergency response
• CSR monitoring (audio and video)
• Scorecards for phone and email
• IVR post-call survey
• Email survey
• Call-back survey
• Mystery shopper and calibration/call review
• Results
• Overall CDC-INFO customer satisfaction consistently
meets or exceeds industry standard (75%)
• 50% of survey respondents indicate a behavior change
was made because of CDC-INFO health information
they received
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Caller Demographics: Age
Age of CDC.gov Users
Age of CDC-INFO Callers
65+
3%
65+
8%
0-34
39%
50-64
23%
0-34
29%
50-64
33%
Age of U.S. Population
65+
13%
35-49
30%
35-49
35%
Sample Size: 77,624
50-64
18%
Sample Size: 1,297
0-34
47%
•CDC-INFO callers are younger and
older than CDC.gov users
35-49
22%
Source: CDC-INFO demographics are from
IVR Automated Survey
Caller Demographics: Gender
Gender of CDC-INFO Callers
Gender of CDC.gov Users
Male
28%
Male
34%
Female
66%
Sample Size: 78,092
Female
72%
Gender of U.S. Population
Source: ACSI Survey, 2006
•CDC-INFO callers are disproportionately female
Male
49%
Female
51%
Caller Demographics: Race
Race/Ethnicity of CDC.gov Users
Race/Ethnicity of CDC-INFO Callers
White
70%
White
53%
Black/African
American
22%
Other
4%
Black/African
American
21%
Hispanic/Latino
17%
Other
2%
Asian
4%
Race/Ethnicity of U.S. Population
White
66%
Black/African
American
13%
Other
2%
Hispanic/Latino
15%
Asian
4%
Hispanic/Latino
1%
Source: ACSI Survey, 2006
Sample Size: 76,715
•CDC-INFO callers are disproportionately
Black/African American
Asian
6%
Customer Satisfaction
Source: EMT, Dec. 2008
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CDC-INFO Impact: Health Behavior Change
Source: EMT Call Back Survey Results Dec. 2008
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CDC-INFO Impact: Partners
•
19% of incoming calls are from partners*
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•
•
•
State and Federal coordination during emergency response
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•
State and local governments
Health professionals
Technical “peer-to-peer” call handling needed
Provide assistance with call and email handling
• Iowa – statewide mumps outbreak
• Rhode Island – meningitis in schools
• FEMA – Hurricane Katrina during and after, formaldehyde in trailers
• FDA – Various food outbreaks
• DoD – Camp LeJeune
• New Jersey – Hepatitis outbreak
• New York – H1N1
Partner Engagement Opportunities
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•
•
Tailor content specific to partners for emergencies and other events
Cross-promotion across other CDC channels (www.cdc.gov/partners,
Partnership Matters, etc.)
Resource to partners on public health trends to inform communication and
response strategies
* 13.8% English and 4.9% Spanish selected the Medical Professional picks on the IVR.
Includes Physicians with patients and health departments
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CDC-INFO’S ROLE IN
EMERGENCY RESPONSE
CDC-INFO & Emergency Response
CDC-INFO Surge Response
• CDC-INFO serves as the contact center
for HHS resources in the event of
pandemic flu or other disease outbreaks
Agency Impact
• The IVR (call menu system) allows for
pre-recorded or on-the-fly messages
about events or campaigns
• CDC-INFO implemented a state-of-the-art
system that provides critical surge
capacity to respond to 98,000 to 273,000
calls per day – with an average call time
of 3 minutes – based on the American
Red Cross experience during Hurricane
Katrina
• OMB approved surveillance questions
that CSRs will ask during events
•17 questions for Health
Professionals
•12 questions for General Public
• Federal Coordinator brings together
other Federal agencies to ensure
resource sharing, standard protocol
adherence, and inter-connectivity
before, during and after an event.
• CDC-INFO increases response capacity
for public and healthcare provider
inquiries in emergency and natural
disaster events, disease outbreaks and
media events
• CDC-INFO extends state and local
responder capacity during high volume
and after hours inquiries
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How CDC-INFO Responds
During Emergencies
Stage 1
Notification and
Activation
• Triggers
• Inquiry volume
assessment
• Selection of contact
center staffing option
• Requirements Gathering
• Cost/Partner
Assessment
Multi-Stage
Scalability
Process
Stage 2
Mobilization
Stage 3
Operations
• Staffing ramp up
• Event Training
• Content updates
• IVR set up and
routing
• Inquiry volume
tracking
• FAQ/Content Tracking
• Reporting
• CSR Communication
• Quality Monitoring
• Technology enabled
Stage 4
Demobilization
• Staffing ramp down
• Inquiry volume
tracking
• Deactivation of surge
SOP, IVR and call
routing
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Stage 5
Recovery/ Lessons
Learned
• Steady state staffing
• Lessons learned
analysis
CDC-INFO & Salmonella
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CDC-INFO & H1N1
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Timeline
•
•
MMWR Dispatch
Vol. 58 / April 21, 2009
•
Swine Influenza A (H1N1) Infection in Two Children —
Southern California, March–April 2009
•
On April 17, 2009, CDC determined that two cases of febrile
respiratory illness occurring in children who resided in adjacent
counties in southern California were caused by infection with a
swine influenza A (H1N1) virus. The viruses from the two cases
are closely related genetically, resistant to amantadine and
rimantadine, and contain a unique combination of gene segments
that previously has not been reported among swine or human
influenza viruses in the United States or elsewhere. Neither child
had contact with pigs; the source of the infection is unknown.
Investigations to identify the source of infection and to determine
whether additional persons have been ill from infection with similar
swine influenza viruses are ongoing.
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Timeline – 4/21/2009
• 4:17 PM - Influenza Coordination Unit
sends “heads up” to CDC-INFO
Leadership
• 4:18 PM – Content Team asked to
develop Log Call. Contact Center
management team notified of potential
surge
• 5:30 PM – Log Call process initiated at
CDC-INFO Contact Center
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Crisis + Emergency Risk Communication
(CERC)
• Communicating in a crisis is different
• In a serious crisis, all affected people…
• Take in information differently
• Process information differently
• Act on information differently
• Be first, be right, be credible
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CERC
• 5 public concerns
•
•
•
•
Gain wanted facts
Empower decision making
Involved as a participant, not spectator
Provide watchguard over resource
allocation
• Recover or preserve well-being and
normalcy
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JIC Rhythm
TIME
JIC TEAM
ACTIVITY: 0700 - 0700
0700
1st Shift Begins
0730
1st Shift JIC ALL Call
877-937-3488, PC:630905#
JIC ALL
0930
Laboratory Meeting-
866-705-3028, PC:1518754
LOCS, CCT
0800
Directors Update ( BLdg 21-12105
0930
Swine Influenza Team Lead/SME Fusion Meeting/ECR 866-556-4957, PC:1519910
CCT
0945
NICCL Call
lead
1100
Team SITREP Bullets due to [email protected]
1100
ESF-8 Initial Coordination Swine Flu Conf Call
1200
SITREP/IAP Inputs due to Plans
1230
HHS/CDC Press Conference
1300
EPI Investigation Conf call
1300
International VTC
1400
1st shift Team reports due to teams and admin
1430
2nd Shift Begins--SHIFT CHANGE JIC ALL BRIEF
1530
ASTHO-NACCHO Plans
800-988-9646, 99980
JIC Lead
1700
CDC Only Leadership Meeting (ECR)
866-566-0674. 2560103
Lead
1800
International Tri Lateral Conf Call
JIC ALL
866-566-0674, 2560103
800.320.4330, PC: 992008#
JIC Lead
JIC ALL
800-988-9371,85590
Co-lead
JIC Lead
866-859-4922, PC:5075142
(Bldg 21-3025A)
EPI-X
Global
JIC ALL
877-937-3488, 630905#
(Bldg21-3025A)
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JIC ALL
Global
JIC Teams
•
•
•
•
•
•
•
•
•
•
•
•
•
• CDC-INFO
IMT
CCT
Epi-X
Web
Media
Research
Partners
Enterprise
Global
CHET
PHWF
Social Media
EOC Liaison
34
Daily H1N1 Log Call Report
35
Interactive Voice Response 4/24
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Interactive Voice Response (IVR)
Prevention messaging…April 24th
• "There are everyday actions that can help prevent the
spread of germs that cause respiratory illnesses like
influenza. Take these everyday steps to protect your health:
Cover your nose and mouth with a tissue when you cough or
sneeze; Throw the tissue in the trash after you use it; Wash
your hands often with soap and water, especially after you
cough or sneeze; Alcohol-based hand cleaners are also
effective; Try to avoid close contact with sick people; If you
get sick with influenza, CDC recommends that you stay
home from work or school and limit contact with others to
keep from infecting them. Avoid touching your eyes, nose or
mouth- Germs spread this way."
37
Interactive Voice Response – 4/30
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Top 10 Prepared Responses
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•
•
•
•
•
•
•
•
•
What are the signs and symptoms of novel H1N1 flu?
What are CDC's recommendations regarding travel during the
novel H1N1 flu outbreak?
How can human infections with novel H1N1 flu be diagnosed?
Where can I get tested for novel H1N1 flu?
How does novel H1N1 flu spread?
What can I do to protect myself from getting novel H1N1 flu?
When should I seek emergency or immediate care for a
person with novel H1N1 flu?
What is the incubation period (time between exposure and
when symptoms start showing) for novel H1N1 flu?
What antiviral medications are available by prescription to
treat novel H1N1 flu infections in humans?
What should I know about using facemasks or respirators
when concerned about the spread of novel H1N1 flu?
39
JIC Communications Activities
40
Calls Answered vs. Abandoned Metrics During
H1N1 Event
41
Call
Count
04
/
04 22 /0
/
04 23 / 9
/ 0
04 24 /0 9
/
04 25 / 9
/ 0
04 26 /0 9
/
04 27 /0 9
/
04 28 / 9
/ 0
04 29 /0 9
/
05 30 / 9
/ 0
05 01 /0 9
/
05 02 / 9
/ 0
05 03 /0 9
/
05 04 / 9
/ 0
05 05 /0 9
/
05 06 /0 9
/
05 07 / 9
/ 0
05 08 /0 9
/
05 09 / 9
/ 0
05 10 /0 9
/
05 11 / 9
/ 0
05 12 /0 9
/
05 13 / 9
/ 0
05 14 /0 9
/
05 15 /0 9
/
05 16 / 9
/ 0
05 17 /0 9
/18 9
/0
9
H1N1 Inquiries vs. All Other Call Topics
H1N1 Phone Inquiries vs. All Other Phone Inquiries
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
-
H1N1 Innquiries
All other Inquiries
Date
42
Calls by Region
43
Call by State
44
Clinicians v. General Public
45
Custom Reports for New York State Department
of Health on H1N1 Calls
46
Summary
• Complex program (not just a hotline)
• Grounded in research and evaluation
• Consistent commitment to excellence
in customer service, performance
management, and quality assurance
• Now positioned to realize vision and
strategic plan to advance CDC
communication and customer service
47
Questions/Discussion
Thank You
Thank you!
Susan K. Laird, MSN, RN
[email protected]