June 8, 2004: What are the conclusions of the Institute of Medicine Study?

The Institute of Medicine (IOM) was asked by the Maternal and Child Health Bureau to assist in developing a systematic approach to stabilizing poison prevention and control services.  This report had a significant impact as financial recommendations as well as recommendations for the number of poison centers were included in it.  At one point, a single large center serving the entire country had been considered.  Fortunately the committee did not recommend a single large center.

  The recommendations are as follows:  (My comments are in parenthesis)

1)    All poison control centers should perform a defined set of core activities supported by federal funding that is tied to the provisions of these activities.

2)    Poison control centers should collaborate with state and local health departments to develop, disseminate, and evaluate public and professional education activities.

3)    The U.S. Department of Health and Human Services and the states should establish a Poison Prevention and Control System that integrates poison control centers with public health agencies, establishes performance measures, and holds all parties accountable for protecting the public.  (This recommendation also states that the Governor should assure that relevant all-hazards emergency preparedness and response activities are integrated with the Poison Prevention and Control System.)

4)    The Centers for Disease Control and Prevention, working wit HRSA and the states, should continue to build an effective infrastructure for all-hazards emergency preparedness, including bioterrorism and chemical terrorism.  (A specific activity of this effort is to evaluate through an objective structure review, the use of the Toxic Exposure Surveillance System as a source of case detection to all-hazards surveillance.)

5)    HRSA should commission a systematic management review focusing on organizational determinants of cost, quality, and staffing of poison control centers as the foundation for the future funding of this program.  The committee concluded that the most effective approach to stabilization is through federal funding of approximately $100 million to support the core activities.  This funding would replace the current funding sources. (This was crucial as the concern was that the recommendation might be to decrease funding.)

6)    Congress should amend the current Poison Control Center Enhancement and Awareness Act to provide sufficient funding to support the proposed Poison Prevention and Control System with its national network of regional poison control centers.  (It is worth noting that the committee felt that there should be enhancement of surveillance and data collection activities which required additional support and it was for this additional support that the money was increased.)

7)    Congress should amend existing public health legislation to fund a state and local infrastructure to support an integrated Poison Prevention and Control System.

8)    A fully external, independent body should be responsible for certification of poison control centers and specialists in poison information.   This body should be separate from the professional organizations representing them.

9)    The Secretary of Health and Human Services should instruct key agencies to convene an expert panel to develop a definition of poisoning that can be used in surveillance activities (including the Toxic Exposure Surveillance System) and ongoing data collection studies.

10)     DHHS should undertake a targeted education effort to improve health provider awareness of poisoning data collection as it relates to the Health Insurance Portability and Accountability Act (HIPPA) and state privacy regulations to mitigate their unintended chilling effect on poison control center consultation, including follow-up.

11)      The Director of the Centers for Disease Control and Prevention should ensure that exposure surveillance data generated by the poison control centers and currently reported in the Toxic Exposure Surveillance System are available to all appropriate local, state, and federal public health units and to the poison control centers on a “real time” basis at no additional cost to these users.

12)      Federally funded research should be provided for:  (1) studies on the epidemiology of poisoning; (2) the prevention and treatment of poisoning and drug overdose; (3) health services access and delivery; (4) strategies to improve regulations and facilitate researchers’ input into regulatory procedures; and (5) the cost efficiency of the new Poison Prevention and Control System on population-based outcomes for general and specific poisonings.

All in all, I think the IOM recommendations will help improve federal funding.

I am interested in any questions that you would like answered in “Question of the Week.”  Please e-mail me with any suggestions at donna.seger@Vanderbilt.edu

Donna Seger, M.D.
Medical Director, Tennessee Poison Center