Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis
Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis
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DOI：
10.1186/1471-2458-11-73
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发表时间：
2011-02-01
影响因子：
4.5
通讯作者：
Stoto, Michael A.
中科院分区：
文献类型：
--
作者：
Klaiman, Tamar;Kraemer, John D.;Stoto, Michael A.
背景：学校关闭被用作2009年甲型H1N1流感大流行的非药物干预措施，特别是在第一波期间。美国有700多所学校停课。然而，关闭决定反映了关闭的理由、决定触发因素和权力方面的重大差异。这种可变性为提高效率和决策提供了机会。方法：我们通过监控备受瞩目的消息来源、搜索Lexis-Nexis和Google新闻警报，确定与学校关闭有关的媒体报道是对2009年H1N1流感的回应，并审查报告的关键主题。新闻报道通过观察电话会议和与卫生部门和学校官员的会议，以及与决策者和社区成员的讨论来补充。结果：关闭决定的既定目标存在显著差异，包括限制病毒的社区传播，保护特别脆弱的学生，以及应对人员短缺或学生缺勤。由于关闭的目标与其时机、性质和持续时间有关，关闭的理由不明确可能会挑战其有效性。在不同司法管辖区关闭学校的决策权也有很大差异，在某些情况下，这反映在学校和公共卫生官员之间的公开分歧上。最后，决策者似乎没有预料到大流行早期遇到的科学不确定性水平，他们经常对疾控中心指导方针的改变表示极大的失望。结论：通过确保官员澄清关闭的目标并根据这些目标调整关闭决定，可以改进将学校关闭作为应对流行病的公共卫生对策。此外，关闭学校的权力应该事先得到明确，决策者应该预料到会出现不确定的疾病紧急情况，并制定相应的计划。
Background: School closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making.Methods: We identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members.Results: There was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance.Conclusions: The use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly.