RAC Risk Ranking Models RAC Risk Ranking Models WorkshopWorkshop

RAC Risk Ranking Models RAC Risk Ranking Models WorkshopWorkshop

Consequence Management SystemConsequence Management System

August 18, 2005August 18, 2005

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Purpose of the CMSPurpose of the CMSPurpose of the CMSPurpose of the CMS

To help quantify the potential To help quantify the potential consequencesconsequences of food safety and defense eventsof food safety and defense events

To help quantify the potential To help quantify the potential consequencesconsequences of food safety and defense eventsof food safety and defense events

Estimate the impact on:Estimate the impact on: Consumers Consumers Public Health infrastructure Public Health infrastructure Business, government and the public Business, government and the public Alternative interventions Alternative interventions Facilities (containment and remediation)Facilities (containment and remediation)

Training and education Training and education

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What policy issues does CMS address?What policy issues does CMS address?What policy issues does CMS address?What policy issues does CMS address? Vulnerable agent/food combinationsVulnerable agent/food combinations

Helps identify which combinations of agent/food have the Helps identify which combinations of agent/food have the largest potential for scope and scale of outbreaklargest potential for scope and scale of outbreak

Critical control pointsCritical control points Helps identify where to focus resources in the food Helps identify where to focus resources in the food

distribution/endpoint chain for most benefitdistribution/endpoint chain for most benefit

Cost effectivenessCost effectiveness Helps weigh the cost/benefit of various policy and intervention Helps weigh the cost/benefit of various policy and intervention

decisions decisions

Time framesTime frames Illustrates the time frames that would maximize the Illustrates the time frames that would maximize the

effectiveness of policies and actionseffectiveness of policies and actions

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How is CMS structured?How is CMS structured?How is CMS structured?How is CMS structured?Simulates the evolution and impact of an entire Simulates the evolution and impact of an entire

food event temporally and geographicallyfood event temporally and geographically

Data-centricData-centric - reflect real data and real prior - reflect real data and real prior incidentsincidents

VisualVisual - quickly visualize and assess the impact of - quickly visualize and assess the impact of decisions decisions

FlexibleFlexible - accommodate all reasonable scenarios - accommodate all reasonable scenarios PracticalPractical – operate when some attributes are unknown – operate when some attributes are unknown

or impreciseor imprecise ExtensibleExtensible – facilitate easy enhancement to include – facilitate easy enhancement to include

improved data and models as they become availableimproved data and models as they become available

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Example of use of CMSExample of use of CMSExample of use of CMSExample of use of CMS

CMS DemonstrationCMS Demonstration

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Software platformSoftware platformSoftware platformSoftware platform

Windows 2000/XPWindows 2000/XP

Implemented as original program Implemented as original program code.code.

All required components are All required components are included with CMS installationincluded with CMS installation

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What does CMS deliver ? . . . What does CMS deliver ? . . . What does CMS deliver ? . . . What does CMS deliver ? . . . ““What-If” scenario planningWhat-If” scenario planning

Quantify vulnerabilitiesQuantify vulnerabilities Assist in priority settingAssist in priority setting Facilitate allocation of resourcesFacilitate allocation of resources Support decision makingSupport decision making

Consequence assessmentConsequence assessment Morbidity, mortality, economic impactMorbidity, mortality, economic impact All impacted constituencies All impacted constituencies (consumers, general (consumers, general

public, health care industry, global and domestic food public, health care industry, global and domestic food industries, government) industries, government)

TrainingTraining Food system, agents, crisis managementFood system, agents, crisis management Table top exercises Table top exercises

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. . . and to whom?. . . and to whom?. . . and to whom?. . . and to whom? Federal agenciesFederal agencies

FDA, DHS, CDC, USDA, EPAFDA, DHS, CDC, USDA, EPA

State and local agenciesState and local agencies Departments of Public Health, Agriculture, Homeland Departments of Public Health, Agriculture, Homeland

Security, Emergency Response, First respondersSecurity, Emergency Response, First responders

Industries expressing interestIndustries expressing interest Grower/shippers, manufacturers, suppliers, Grower/shippers, manufacturers, suppliers,

transportation, wholesalers, distributors, transportation, wholesalers, distributors, retail/foodservice operatorsretail/foodservice operators

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Public Health outcome metricsPublic Health outcome metricsPublic Health outcome metricsPublic Health outcome metrics

User selectable User selectable Supports any metric that:Supports any metric that:

allows interpolation between symptom levelsallows interpolation between symptom levels correlates with impact metricscorrelates with impact metrics allows evaluation of economic costs allows evaluation of economic costs (desirable)(desirable)

Example:Example: Mild Illness (no time off work)Mild Illness (no time off work) Moderate Illness (1 – 5 days off work)Moderate Illness (1 – 5 days off work) Severe Illness (6 + days off work, no hospitalization)Severe Illness (6 + days off work, no hospitalization) Short Term Hospital Admission (1 - 5 days)Short Term Hospital Admission (1 - 5 days) Long Term Hospital Admission (6+ days)Long Term Hospital Admission (6+ days) MortalityMortality

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Economic outcome metricsEconomic outcome metricsEconomic outcome metricsEconomic outcome metrics

User selectableUser selectable Supports any outcome metric that:Supports any outcome metric that:

allows interpolation between impact levelsallows interpolation between impact levels has supporting datahas supporting data

Examples:Examples: QALYQALY DALYDALY DollarsDollars

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How transparent is CMS?How transparent is CMS?How transparent is CMS?How transparent is CMS?

All data are anonymized and viewable with All data are anonymized and viewable with provided Data Entry/Viewing moduleprovided Data Entry/Viewing module Data Entry moduleData Entry module

All statistical distributions are viewable with All statistical distributions are viewable with provided code-shared statistics moduleprovided code-shared statistics module Statistics ModuleStatistics Module

Complex processes may be modeled via Complex processes may be modeled via external modeling systems:external modeling systems: Where external model is compatible (API) and appropriate (real-time speed) Where external model is compatible (API) and appropriate (real-time speed)

they may be called directlythey may be called directly

Outputs of incompatible external models (e.g. Analytica) are recoded as Outputs of incompatible external models (e.g. Analytica) are recoded as inputs for the CMSinputs for the CMS

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What data does CMS need? What data does CMS need? ((Year 1)Year 1)What data does CMS need? What data does CMS need? ((Year 1)Year 1)

Food SourcingDeterministic information

Interviews with producers Trade associations, USDA/ERS data.

Food HandlingModels

Literature ReviewFood Handling Practices Model

Agent CharacteristicsDeterministic informationExpert Panel ,Literature Review

Agent-Food InteractionModels

E. Todd model - E. coli on lettuce

Food ConsumptionDeterministic informationERS NHANES II data from USDANPD data on lettuce consumption

Secondary TransmissionExpert Elicitation

Expert elicitation with FDA, CDC

Dose ResponseExpert Elicitation

Expert elicitation with FDA. CDCNCFPD PH Response and Epi Team

Disease ProgressionExpert Elicitation

Expert elicitation with FDA, CDCNCFPD Model

Patient ResponseExpert Elicitation

Expert elicitation from CDCNCFPD PH Response and Epi Team

Health System ResponseExpert Elicitation/Model

Expert elicitation with FDA/CDC, State and local PHD; NCFPD Model

Intervention ImpactExpert Elicitation/Model

Expert Elicitation with FCFPD and IndustryBT Safety designed system

Event ImpactModel

ERS code for Cost Calculator (Salmonella)NCFPD Economics Team

Data Repository TabsLiterature Review

Food DistributionDeterministic information

Industry provided data

Food ProcessingDeterministic information

Interviews, Literature Review

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. . . Data Gaps? . . . Data Gaps? (Year 1)(Year 1). . . Data Gaps? . . . Data Gaps? (Year 1)(Year 1)

Food Sourcing Food Distribution

Food HandlingAgent

CharacteristicsAgent-Food Interaction

Food ConsumptionSecondary

Transmission Dose Response

Disease Progression Patient Response

Data Repository

Food Processing

Health System Response

Intervention Impact Event Impact

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How do you compensate for missing data?How do you compensate for missing data?How do you compensate for missing data?How do you compensate for missing data?

Hierarchically structured approachHierarchically structured approach Internet searchInternet search Literature reviewLiterature review Expert elicitationExpert elicitation Original data collection/researchOriginal data collection/research

Ongoing dialog with experts in relevant Ongoing dialog with experts in relevant fieldsfields

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We gratefully acknowledge We gratefully acknowledge funding by the following funding by the following

organizations:organizations:

We gratefully acknowledge We gratefully acknowledge funding by the following funding by the following

organizations:organizations: