Factors that influence state written pandemic flu plan inclusion of federal recommendations

The threat of a pandemic influenza outbreak is considered imminent and could cause severe morbidity and mortality as well as devastating economic losses. The U.S. government has worked to empower states to respond to a pandemic, but there has been minimal evaluation to determine the success of such efforts. The purpose of this study was to examine states' preparedness for a pandemic as documented by states' written pandemic plans and evaluate what political and structural factors may be associated with pandemic plan inclusion of federal recommendations.;This was a cross-sectional comparative analysis of 50 states' pandemic influenza plans as of March 2008. The Centers for Disease Control and Prevention's (CDC) State and Local Pandemic Influenza Planning Checklist was turned into a matrix with each of 85 recommendations making up 10 overarching domains coded as "no mention" = 1, "brief mention but no description or action item" = 2, or "description or action of the item" = 3. Forty-nine complete plans and one state's plan summary were included in the analysis. Each state's domain scores were calculated by adding the scores of each factor within the domain. A "total preparedness score" for each state, was derived by adding the unweighted scores of each domain. Federal recommendations surrounding leadership, networking and surveillance have been well-integrated, but greater efforts are needed to develop partnerships with health care agencies and to focus on antiviral preparedness and infection controls.;Federal and state governments have invested resources in pandemic planning and published recommendations for such planning; however, little research has been conducted focusing on what predicts integration of federal recommendations in written state plans. Understanding the factors that influence state plans can offer health departments strategies for increasing their effectiveness in pandemic preparedness and response. This study compared models for bureaucratic behavior and health department structural variables to evaluate what factors may be associated with pandemic plans. The findings showed that structural variables offer greater explanation for pandemic plan comprehensiveness than political theory models, but more work is needed to glean causal relationships. Recommendations to assist state health departments, legislators, and responders in improving state pandemic plans are presented as well as suggested areas for future research.