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BACKGROUND: In 2000, the New Jersey Department of Health (NJDOH) began to build local epidemiology capacity by providing federal funds to each of New Jersey’s (NJ) 22 Local Information Network Communications Systems (LINCS) agencies to hire a master’s trained epidemiologist. LINCS epidemiologists provided services related to communicable disease investigations/outbreaks for the jurisdictions covered by their agency. In 2013, 23 epidemiologists were functioning in this capacity; however, LINCS agency-based epidemiologists were problematic as local health department access to epidemiologic services was often limited to those municipalities directly supported by LINCS agencies. NJDOH provided some mentorship and training of epidemiologists via monthly meetings but guidance and support at the LINCS-level was limited. In addition, LINCS epidemiologists became involved in activities outside of the intended scope of the position (e.g., grants management, health planning) thereby decreasing their work on epidemiologic investigations/responses. As federal funds declined, NJDOH explored several options to improve epidemiologic services provided statewide while trying to reduce costs for these services.
METHODS: After careful deliberation, NJDOH decided to reduce the number of epidemiologists and relocate these assets to NJDOH, with each epidemiologist covering one of five regions (northeast, northwest, central west, central east, south); of these epidemiologists, some would serve as supervisors for a given region. In July 2013, NJDOH formed a planning group and began developing a strategy to centralize field epidemiology services. Several documents and protocols were created and shared with public health partners (e.g., local health officers, hospital infection preventionists) to ease the transition of epidemiologic services from the local health departments (LHDs) to NJDOH.
RESULTS: By early 2014, NJDOH hired nine of eleven epidemiologists, and by October had a full complement of regional epidemiology staff. The Regional Epidemiology Program (REP) is fully integrated into NJDOH Communicable Disease Service and works closely with NJ’s 97 LHDs and NJDOH-based disease experts on communicable disease investigations/ outbreaks. The centralization along with the REP’s management structure fosters mentorship and ensures a consistent public health response statewide. Quarterly meetings and reports have also been established to keep local public health partners informed and engaged.
CONCLUSIONS: Epidemiologic capacity at both the state and local level is critical for public health response. Ensuring that these services can be provided in a manner which is both economical and adequate can be challenging. Centralization of epidemiologic services, where standardized services are split among geographic regions, is one way to overcome hurdles faced by many states as resources continue to dwindle.