title: Community planning for pandemic influenza: lessons from the VA health care system.
abstract: BACKGROUND
  Coordination and communication among community partners-including health departments, emergency management agencies, and hospitals-are essential for effective pandemic influenza planning and response. As the nation's largest integrated health care system, the US Department of Veterans Affairs (VA) could be a key component of community planning.
  
  
  OBJECTIVE
  To identify issues relevant to VA-community pandemic influenza preparedness.
  
  
  METHODS
  As part of a VA-community planning process, we developed and pilot-tested a series of tabletop exercises for use throughout the VA system. These included exercises for facilities, regions (Veterans Integrated Service Networks), and the VA Central Office. In each, VA and community participants, including representatives from local health care facilities and public health agencies, were presented with a 3-step scenario about an unfolding pandemic and were required to discuss issues and make decisions about how the situation would be handled. We report the lessons learned from these pilot tests.
  
  
  RESULTS
  Existing communication and coordination for pandemic influenza between VA health care system representatives and local and regional emergency planners are limited. Areas identified that would benefit from better collaborative planning include response coordination, resource sharing, uneven resource distribution, surge capacity, standards of care, workforce policies, and communication with the public.
  
  
  CONCLUSIONS
  The VA health system and communities throughout the United States have limited understanding of one another's plans and needs in the event of a pandemic. Proactive joint VA-community planning and coordination-including exercises, followed by deliberate actions to address the issues that arise-will likely improve pandemic influenza preparedness and will be mutually beneficial. Most of the issues identified are not unique to VA, but are applicable to all integrated care systems.
authors.affiliation: RAND Corporation, Arlington, VA 22202, USA. lurie@rand.org
authors.forename: Nicole
authors.initials: N
authors.lastname: Lurie
authors.forename: David J
authors.initials: DJ
authors.lastname: Dausey
authors.forename: Troy
authors.initials: T
authors.lastname: Knighton
authors.forename: Melinda
authors.initials: M
authors.lastname: Moore
authors.forename: Sarah
authors.initials: S
authors.lastname: Zakowski
authors.forename: Lawrence
authors.initials: L
authors.lastname: Deyton
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D004189:Disaster Planning / Q000458:organization & administration*; D004196:Disease Outbreaks; D006285:Health Planning / Q000458:organization & administration; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D010865:Pilot Projects; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans