The U.S. government has worked to empower states to respond to a pandemic, but there is 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. The study was a cross-sectional comparative analysis of 50 states' pandemic influenza plans as of March 2008. The CDC's 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. Domain scores were constructed by summing each state's factor scores and dividing the sums by the total possible score for that 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 focus on antiviral preparedness and infection controls. The use of a clearly defined measurement tool can help states determine their level of preparedness and look to more prepared states for guidance as well as lobby their legislatures for additional resources.
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