e. samoff mph phd, a. t. fleischauer msph phd, l. dibiase ms, m. davis mph, a. waller scd,
DESCRIPTION
North Carolina Preparedness & Emergency Response Research Center (NCPERRC). Local health department electronic reportable disease surveillance practice and costs, North Carolina, 2009 OR: Proving it out. - PowerPoint PPT PresentationTRANSCRIPT
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Local health department electronic reportable disease surveillance practice and
costs, North Carolina, 2009OR: Proving it out
E. Samoff MPH PhD, A. T. Fleischauer MSPH PhD, L. DiBiase MS, M. Davis MPH, A. Waller ScD,
P. D. M. MacDonald MPH PhD
This research was carried out by the North Carolina Preparedness and Emergency Response Research Center (NCPERRC) which is part of the UNC Center for Public Health Preparedness at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health and was supported by the Centers for Disease Control and Prevention (CDC) Grant 1PO1 TP 000296. The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. Additional information can be found at http://cphp.sph.unc.edu/ncperrc/
North Carolina Preparedness & Emergency Response Research Center (NCPERRC)
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Background
• All states now use an electronic disease surveillance system
• What we know– Increase speed of initial notification to public health and number of
cases reported– Facilitate data capture and review
• What we don’t know– Does electronic disease surveillance improve public health
surveillance practice?– Support public health interventions?– Is electronic disease surveillance more efficient or cost-effective?– Improve population health?
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Background
• Project: To evaluate North Carolina’s electronic disease surveillance system
• Project objectives– Describe workforce resources used for electronic
disease surveillance system – Describe impact on case reporting and
surveillance practice– Identify best practices for electronic disease
surveillance
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Background
• North Carolina Electronic Disease Surveillance System (NC EDSS)– Highly customized off-the-shelf Maven system– Implemented in 2008– All reportable diseases except syphilis and HIV
• Case data entered by – LHD staff – Laboratories via ELR (≈ 33% of cases)– State staff
• System offers additional surveillance capacities
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Methods
• Random sample: 30/100 counties• Interviews– NC Electronic disease surveillance system (NC EDSS) lead• Staff # and hours• Use of NC EDSS system• Use of surveillance data
– CD Nurse• Case management • Use of NC EDSS system
• Cost– $29/hour ($60,552/yr) salary
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Methods
• NC EDSS system data– All VPD, STD, and other CD cases– Number of cases– Timeliness: % reported to state within 30 days– Accuracy: % of cases returned by state to LHD– Currently ignored cases: % of cases never handled
>45 days old
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Methods
Composite score for indicators of good reporting practice:– Assigned 1 point each for:– Timeliness (>79% of completed cases submitted to state in <30
days)– Accuracy (<17% of cases returned to LHD for corrections)– Ignored cases (<1% of total cases ignored after 45 days)
• High/low comparison: High (2/3 points) vs. Low (0/1 points)
• County size: Small: <55,654, Medium: 55,655 - 107,427, Large: >107,427
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Results: Respondent Profile
• May-August 2010• 28 counties• Broad geographical distribution
• Broad population distribution– 8,888-923,944 population– 10 small, 8 medium, 10 large
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Results: Cases
• Total number of cases reported: 10,809
0
500
1000
1500
2000
2500Number of cases by county size
County size
Num
ber o
f cas
es
Smaller Larger
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Results: Staff using electronic disease surveillance• Total staff using NC EDSS– 136 employees, 34.5 FTEs– average 4.8 employees, 1.2 FTEs per county
• Type of staff– CD nurses/supervisors– Administrative staff– DIS– Laboratory personnel
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Results: Staff time
• 69% of employees using NC EDSS spent <12 hours per week of their work time on the system
Proportion of work time spent on NC EDSS
≥24 hours per week12-23 hours per week<12 hours per week
69%
10%
21%
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Results: Staff expenditure (FTEs)
0
0.5
1
1.5
2
2.5
3
3.5Number of FTEs per 100,000 population
County size
Num
ber o
f FTE
s pe
r 100
,000
Smaller Larger
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Results: Cases reported per FTE
• Average of 68 cases reported per FTE per month
020406080
100120140160180
County size
Num
ber o
f cas
es/F
TE/m
onth
Smaller Larger
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Results: Salary cost per case reported
0
200
400
600
800
1000
Cost per case reported
County size
Sala
ry c
ost p
er c
ase
in d
olla
rs
Smaller Larger
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Results: Salary cost per case reported
0
50
100
150
200
250
300
350Cost per case reported
County size
Sala
ry c
ost p
er c
ase
in d
olla
rs
Smaller Larger
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Results: Impact on case reporting and surveillance practice
• NC EDSS leads: – 68% (19/28): Reported changes in case management– 89% (17/19): Improvement
• CD nurses: – 57% (12/21): Reported changes in case management– 75% (9/12): Improvement
• Because– Increased timeliness– Easier to know what to do/ask– Easier to access case-patient data– More thorough documentation
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Results: Impact on case reporting and surveillance practice
• Counties using >5 NC EDSS capacities are more likely to– Report using surveillance data for decisions about
public health program management– Report providing surveillance data to policy-makers– Report including surveillance data in annual reports– Report using data from extended surveillance form
for disease intervention
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Results: Reporting performance rank
• Rank based on – Timeliness (>82% submitted to NC DPH within 30 days)– Accuracy (<17% of cases returned to LHD)– Incomplete cases (<1% cases incomplete longer than 45 days
0
1
2
3
County size group
Rank
Small Medium Large
Rank=0
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Mean cost per case by reporting practice rank
0 points 1 point 2 points 3 points0
50
100
150
200
250
Rank
Cost
per
cas
e in
dol
lars
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Mean cost per case by rank and county size
0
50
100
150
200
250
300
350
Low rank (0/1)High rank (2/3)
County size group
Mea
n co
st p
er c
ase
Small Medium Large
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Good surveillance costs less. How do we get there?
Practices associated with high reporting performance
• Can look at incoming cases daily (P=.11)• 6 staff or fewer using NC EDSS (P=.02)• Use surveillance data for program evaluation
(P=.13)• >5% of cases=Not a case (P=0.22)
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Limitations
• FTE data are reported by interviewee – Not verified by electronic system– Based on current user lists
• Does not represent multi-county LHDs as well• Interviewer bias
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Conclusions
• Resources used per case reported differs across state– Good surveillance costs less
• Perceived improvement in case management and disease surveillance
• Electronic surveillance system is supporting key surveillance activities
• Daily use of electronic surveillance system by a focused user group supports good reporting practice
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Acknowledgements
UNC Gillings School for Global Public Health
Pia MacDonald MPH PhDCarol Gunther-Mohr MAMeredith Davis MPHLauren Dibiase MPHHeidi Soeters MPHErika Samoff MPH PhD
UNC School of Information and Library Science
Stephanie W. Haas PhD
Carolina Center for Health Informatics / UNC Dept of Emergency Medicine
Anna Waller ScDAmy Ising MSIS
CDC/NC Division of Public HealthAaron Fleischauer PhD