Infectious illness logic model aids planning, response

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Adapting a logic model that followed alert levels for infectious illness provided needed flexibility for the H1N1 pandemic that emerged in 2009. The process of modifying the model also offered useful lessons about partnerships to University of Michigan (U-M) staff.

The logic model was first created to help planners identify triggers for U-M actions, based on a scenario involving emergence of an avian influenza-style infection that became a full-fledged human pandemic. After H1N1 was identified in April 2009, U-M's all-hazards planning group dusted off the initial model and examined it from a new perspective, said Andy Burchfield, manager of the U-M Office of Emergency Preparedness, who convenes the all-hazards planning team and helped to coordinate response.

As the H1N1 pandemic unfolded, it did not resemble the planning scenario, Burchfield noted. "We recognized as a group there were some things we needed to evaluate. One of those was the WHO (World Health Organization) chart."

The logic model (similar to a chart then used by the WHO) was meant to trigger actions but had the effect of limiting U-M incident managers from responding in ways that seemed to fit the circumstances. For instance, their working model called for stopping some U-M activities in a major outbreak, but that did not seem appropriate because, "We weren't seeing high rates of morbidity or mortality on campus."

So as they mapped out the university's response to the H1N1 pandemic, the group also revised the model. It reached its current form around the end of August, 2009, Burchfield said.

Changes included: Shifting from the word "pandemic" to "infectious illness," to allow more flexibility in using the model; and simplifying the model to its current "A-B-C" form (see current model in the link below).

Discussions about whether and how to change triggers have been happening at all levels of government. Burchfield said the group did not feel the need to rely on specific numbers or rates of illness and death. "People felt really comfortable in understanding what was a dangerous situation versus one that we could handle," he said. Thinking through the existing triggers and other options "gave people a really good comfort level in how they were responding to things."

The value of revising the logic model was working through it as a group, he added. "You could and probably would use it in some circumstances during the actual event, but as you're planning and preparing and ramping up, I think that's the time where it is of most value."

U-M's process resulted in stronger preparedness materials and partnerships, he added. "You've got to keep it simple for people, and having the collective group work together is beneficial. The more time you can spend on these processes and vetting this kind of stuff out with a group of people the better you will be at making things happen when action is required."

"This isn't a steadfast, hard guide. It allows us to try to logically make some decisions," Burchfield said. The all-hazards planning committee members shared that message in the university community, and "once they understood this, people seemed comfortable that the university had a model they were following."

The model is still subject to change as circumstances dictate, but Burchfield said it is much more robust as a result of U-M's discussions and H1N1 experiences. Even though it is ready to be used, Burchfield added, "I hope I don't have to look it up for quite a while."

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