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Background: The outbreak of Ebola virus disease in West Africa and confirmation of the first cases in the United States highlight the need for robust and responsive public health surveillance system. With a 25% decline in funding since 2007, the impact on local surveillance capacities has not previously been described. Purpose: The Surveillance & Investigation domain of the Local Health Department Preparedness Capacities Survey (PCAS) was reweighted to reflect the national profile of LHDs. Changes in subdomain performance of capacities and the effect of population size on subdomain capacity performance were examined over time. Methods: Participating LHDs (n=208) from the PCAS sample were reweighted according to characteristics from the 2010 National Association of County and City Health Officials (NACCHO) Profile. Overall changes in preparedness capacity across four subdomains from 2010 to 2012 were tested for significant differences using a weighted t-test. A series of weighted least squares regression models were used to determine whether population size may have modified the temporal changes in preparedness capacity. Results: Significant declines were observed in the preparedness capacity in three of the four subdomains of Surveillance & Investigation. Results suggest that surveillance inputs from various sources, including hospitals, urgent care, poison control, pharmacies, and schools absentee reporting, especially for larger LHDs, may be more sensitive to changes or shifts over time versus others. Implications: Declines in preparedness capacity may have affected the ability of LHDs, particularly larger ones, to effectively respond to community preparedness needs and, specifically, the detection of highly communicable and novel disease events.

Local health departments (LHDs) are essential to emergency preparedness and response activities. Since 2005, LHD resources for preparedness, including personnel, are declining in the face of continuing gaps and variation in the performance of preparedness activities. The effect of these funding decreases on LHD preparedness performance is not well understood. This study examines the performance of preparedness capacities among NC LHDs and a matched national comparison group of LHDs over three years. We observe significant decreases in five of eight preparedness domains from three years of survey data collected from 2010 through 2012. Most notably, we observe significant decreases in the Surveillance & Investigation domain. Performance decreases may be a result of continued, compounding declines in preparedness funding.

Introduction Many Medicare enrollees do not receive colorectal cancer tests at recommended intervals despite having Medicare screening coverage. Little is known about the physician visits of Medicare enrollees who are untested. Our study objective was to evaluate physician visits of enrollees who lack appropriate testing to identify opportunities to increase colorectal cancer testing. Methods We used North Carolina and South Carolina Medicare data to compare type and frequency of physician visits for Medicare enrollees with and without a colorectal cancer test in 2005. Type of physician visit was defined by the physician specialty as primary care, mixed specialty (more than 1 specialty, 1 of which was primary care), and nonprimary care. We used multivariate modeling to assess the influence of type and frequency of physician visits on colorectal cancer testing. Results Approximately half (46.5%) of enrollees lacked appropriate colorectal cancer testing. Among the untested group, 19.8% had no physician visits in 2005. Enrollees with primary care visits were more likely to be tested than those without a primary care visit. Many enrollees who had primary care visits remained untested. Enrollees with visits to all physician types had a greater likelihood of having colorectal cancer testing. Conclusions We identified 3 categories of Medicare enrollees without appropriate colorectal cancer testing: those with no visits, those who see primary care physicians only, and those with multiple visits to physicians with primary and nonprimary care specialties. Different strategies are needed for each category to increase colorectal cancer testing in the Medicare population.

Colorectal cancer (CRC) screening in the Medicare population remains low despite Medicare coverage. We describe a population-based effort to increase CRC testing of Medicare enrollees in two States through promotion and distribution of office-based tools to primary care physicians and gastroenterologists. Small increases in colonoscopy test use by primary care physicians were observed, but the differences were not statistically significant. Results in one State were stronger than the other, and two components of the intervention appeared more promising than others. Use of CRC tests can be increased, but additional approaches are needed.