A controlled trial of disease surveillance strategies

Active surveillance techniques using routine telephone contacts with providers improved the reporting of measles, rubella, salmonellosis, and hepatitis by a factor of 4.6 among private physicians in Monroe County, New York, and increased reporting for these target diseases from all sources by 51 percent. The timeliness of reporting was not improved by active surveillance. Reporting patterns varied by disease and source of report, suggesting the desirability of various approaches to surveillance based on local resources and priorities. Although reporting rates were higher for diseases among persons from census tracts of low socioeconomic status, physicians providing care to persons living in low-income areas responded no differently to active reporting than did those providing care to patients from middle- and high-income areas.     

Public health surveillance in child-care settings.

To investigate the potential contribution of public health surveillance systems to the health of children and workers in out-of-home child-care settings, we review existing public health surveillance practice in the United States. We identify issues that are of particular concern for surveillance in child-care settings. We propose a framework for developing public health surveillance systems that uses sentinel child-care sites, notifiable disease surveillance, modification of existing surveillance systems, and population surveys. Successful surveillance in these settings depends on the active participation of child-care providers, public health practitioners, and clinicians in (a) the selection of high priority diseases and injuries for surveillance; (b) the development of practical case definitions; (c) the augmentation of current surveillance systems to include disease and injury related to child care; and (d) the implementation, assessment, dissemination, and evaluation of new approaches for surveillance in child-care settings.     

The reporting sensitivities of two passive surveillance systems for vaccine adverse events.

To evaluate reporting sensitivities for vaccine adverse events, reporting rates were estimated by dividing the number of events reported to the Monitoring System for Adverse Events Following Immunization and the Vaccine Adverse Event Reporting System in a given period by the number of doses administered or distributed during the same period. Reporting sensitivity was calculated as the ratio of the rates at which events were reported to each passive surveillance system (numerator) and occurred in controlled studies (denominator). Reporting sensitivities were generally better in the public sector than in the private sector. The significant underreporting of known outcomes, together with the nonspecific nature of most adverse event reports, highlights the limitations of passive surveillance systems in assessing the incidence of vaccine adverse events.     

福建省2004年各类学校突发公卫事件监测结果

目的了解各类学校突发卫生事件的报告及时性与现场处置情况,为有效预防、及时控制各类学校突发卫生事件提供决策依据。方法分析2004年国家突发公共卫生事件报告管理信息系统与福建省文件传输协议(FTP)监测系统的各类突发公共卫生事件。结果各地突发公共卫生事件报告工作不够平衡,有些地市报告工作不够理想;FTP方式是目前的主要报告途径,占各类报告途径的78.02%(71/91);传染性疾病类是各类学校突发公卫事件的主要类型,占89.01%(81/91);春秋两季是学校各类突发公卫事件的好发季节。结论应加强对各级各类学校保健部门督查,提高突发公共卫生事件的报告及时性。     

Automated detection and reporting of notifiable diseases using electronic medical records versus passive surveillance--massachusetts, June 2006-July 2007

Electronic medical record (EMR) systems have the potential to improve reporting of notifiable diseases beyond either traditional clinician-initiated or automated laboratory-based reporting systems. Traditional clinician-initiated passive surveillance is burdensome to clinicians and often incomplete and delayed. Electronic laboratory reporting addresses these limitations but often lacks information needed for public health purposes (e.g., patient signs and symptoms, prescribed treatments, and pregnancy status). Laboratory systems also do not integrate multiple laboratory tests to satisfy a case definition. Many EMRs, however, contain this information and store it in a form that is amenable to electronic analysis and reporting. Consequently, EMR-based reporting has the potential to provide active notifiable disease surveillance that is more timely, complete, and clinically detailed. This report summarizes findings from a pilot EMR-based electronic surveillance system in Massachusetts, which documented increases of 39% in reported chlamydia and 53% in reported gonorrhea for the period June 2006-July 2007, compared with the existing passive surveillance system. Eighty-one instances of pregnancy not identified by passive surveillance were reported by the electronic system in patients with chlamydia or gonorrhea. In addition, the electronic system identified 20 cases of pelvic inflammatory disease and four cases of acute hepatitis A, compared with none and one, respectively, reported via the passive system. Improved reporting can help public health departments better allocate limited resources for targeted investigations and interventions.     

Do consumers respond to publicly reported quality information? Evidence from nursing homes

Public reporting of quality information is designed to address information asymmetry in health care markets. Without public reporting, consumers may have little information to help them differentiate quality among providers, giving providers little incentive to compete on quality. Public reporting enables consumers to choose highly ranked providers. Using a four-year (2000-2003) panel dataset, we examine the relationship between report card scores and patient choice of nursing home after the Centers for Medicare and Medicaid Services began publicly reporting nursing home quality information on post-acute care in 2002. We find that the relationship between reported quality and nursing home choice is positive and statistically significant suggesting that patients were more likely to choose facilities with higher reported post-acute care quality after public reporting was initiated. However, the magnitude of the effect was small. We conclude that there has been minimal consumer response to information in the post-acute care market.     

The effect of underreporting on the apparent incidence and epidemiology of acute viral hepatitis

To determine if passively reported cases of acute viral hepatitis are representative of the affected population, an active surveillance system was set up that identified all persons in Pierce County, Washington, who had been diagnosed by a physician as having acute viral hepatitis in the period March 1 through August 31, 1984. In this county, this was part of an ongoing epidemiologic study of viral hepatitis that had previously included some stimulation of reporting. The active surveillance system covered all primary sources of medical care, including all private physicians who were most likely to see persons with hepatitis. Secondary sources, those that did not provide direct medical care but might be aware of new cases, were also surveyed. The results of active surveillance showed that passive reporting was about 65% complete in Pierce County. No change occurred in the number of hepatitis A cases reported, but hepatitis B cases increased by 50%, and non-A, non-B hepatitis cases increased by 138%. Most of the increase was a result of enhanced reporting from private physicians. The two risk groups most affected by underreporting were homosexual men with hepatitis B and blood transfusion recipients with non-A, non-B hepatitis. During active surveillance, the proportion of persons with hepatitis B who reported homosexual activity was 52% compared with 20% from passive surveillance. Transfusion recipients represented 24% of the non-A, non-B hepatitis reported from active surveillance compared with 9% reported from passive surveillance. Although Pierce County may not be representative of all counties in the United States, persons responsible for public health prevention programs should recognize that data acquired through passive surveillance may not accurately reflect the magnitude of the risk for specific populations or the amount of disease that can be prevented.     

北京市突发公共卫生事件报告信息来源分析

[目的]了解北京市突发公共卫生事件信息的主要来源,为突发公共卫生事件的监测和预警提供依据.[方法]采用回顾性调查的方法对2005年1月1日～2006年6月30日61起网络直报突发事件的最初发现情况和疾控机构初次获得相关信息的情况进行调查.[结果]70.49%(43/61)的突发事件信息来源于卫生系统内部,事件最初发现人主要是门/急诊医务人员,占69.77%(30/43);卫生系统以外的占29.51%,最初发现人主要是教师,占30.23%(13/43).疾控机构最初获得突发事件信息的方式以被动接受报告为主,占78.69%;通过浏览传染病报告卡和网络直报数据分析等主动方式占18.04%.[结论]北京市突发事件信息的来源相对单一,需要进一步加强各部门间的信息沟通,并考虑将突发事件报告职责扩大到学校等集体单位;此外,各级疾控机构应加强突发事件的主动监测,及时分析网络直报数据,提高早期发现疾病暴发的能力,才能有效地预防各类突发事件的发生.     

Public health, data standards, and vocabulary: crucial infrastructure for reliable public health surveillance.

The present, rapid adoption of electronic records in clinical care is likely to shift public health surveillance from passive, human-mediated abstraction to active, computer-generated reports. However, the accuracy and efficiency of this process depends upon the adoption of consistent information standards from beside to population and the relevance of these data to public health. This article outlines the current status of data standards of relevance to public health and expands upon the ideal goal state in which health information would be collected once and then reused for multiple health-related purposes, including public health surveillance.     

Reporting race and ethnicity data--National Electronic Telecommunications System for Surveillance, 1994-1997

Reporting accurate and complete race and ethnicity data in public health surveillance systems provides critical information to target and evaluate public health interventions, particularly for minority populations. A national health objective for 2000 is to improve data collection on race and ethnicity in public health surveillance and data systems. To determine progress toward meeting this goal in CDC's National Electronic Telecommunications System for Surveillance (NETSS), the percentage of case reports of selected nationally notifiable diseases reported through NETSS with information regarding a patient's race and ethnicity was calculated for 1994-1997. The findings of this study indicate these data were received for approximately half of the cases, and the completeness of reporting of race and ethnicity data to NETSS had not improved.     

Exploratory factor analysis and psychometric evaluation of the Healthcare Provider Attitudes Toward Child Maltreatment Reporting Scale

There currently is not a well-established, psychometrically sound measure for assessing health care provider concerns about and attitudes toward reporting maltreatment. The purpose of this study is to examine the psychometric properties of the Healthcare Provider Attitudes Toward Child Maltreatment Reporting Scale. The factor structure and reliability of the scale were analyzed. Two subscales, Reporting Responsibilities and Concerns about Reporting, were identified. The total scale and the subscales were shown to have good internal consistency. Potential uses for the scale in evaluating and improving mandated reporting by health care providers are proposed.     

Evaluating program effects on institutional delivery in Peru

We evaluate the joint effects of two targeted Peruvian health programs on a mother's choice of whether to deliver in a public emergency obstetric care (EmOC) facility. The national maternal and child health insurance, or SMI Program, provided delivery care coverage to Peru's poorest households beginning in 1998. During 1996-2002, Proyecto 2000 sought to improve the quality of EmOC and increase utilization of public EmOC facilities in the districts reporting the highest maternal and neonatal mortality levels. Our data come from the Proyecto 2000 endline evaluation, which sampled 5335 mothers living in the catchment areas of 29 treatment and 29 matched control EmOC facilities. Using propensity scoring and two quality of care indices, we find significantly higher quality of care in Proyecto 2000 treatment facilities. Using variance components logistic models, we find a mother enrolled in the SMI Program was more likely to have delivered her last child in a public EmOC, controlling for household constraints. Residence in a Proyecto 2000 treatment area did not significantly affect the choice. A cross-level interaction term was insignificant, indicating the two program effects were independent.     

Completeness of communicable disease reporting, North Carolina, USA, 1995-1997 and 2000-2006

Despite widespread use of communicable disease surveillance data to inform public health intervention and control measures, the reporting completeness of the notifiable disease surveillance system remains incompletely assessed. Therefore, we conducted a comprehensive study of reporting completeness with an analysis of 53 diseases reported by 8 health care systems across North Carolina, USA, during 1995-1997 and 2000-2006. All patients who were assigned an International Classification of Diseases, 9th Revision, Clinical Modification, diagnosis code for a state-required reportable communicable disease were matched to surveillance records. We used logistic regression techniques to estimate reporting completeness by disease, year, and health care system. The completeness of reporting varied among the health care systems from 2% to 30% and improved over time. Disease-specific reporting completeness proportions ranged from 0% to 82%, but were generally low even for diseases with great public health importance and opportunity for interventions.     

Underdiagnosis of dengue--Laredo, Texas, 1999

Dengue outbreaks have been reported in communities along the Mexico-U.S. border since 1980; however, during 1987-July 1999, no cases were reported from Laredo, Texas (1999 population: 162,000). During January-July 1999, approximately 300-325 dengue cases were reported from Nuevo Laredo, Tamaulipas, Mexico (1999 population: 274,000), a city across the Rio Grande from Laredo. To determine whether undiagnosed or unreported dengue cases had occurred in Laredo, the Texas Department of Health (TDH) reviewed medical records from five Laredo health facilities (the two city hospitals and the three largest of five community clinics). This report summarizes the findings of the review, which indicated that during July 23-August 20, 1999, 50% of suspected case-patients had undiagnosed dengue infection. Recognition of the diagnosis of dengue can be improved through heightened surveillance, professional and public education, and prompt reporting of cases by the health-care providers to local or state health departments.     

2009年山西省妇幼保健机构现状与发展对策分析

目的:了解山西省各级妇幼保健机构现状,为机构自身规范化管理及各级卫生行政部门的科学决策提供指导信息。方法:借助国家妇幼保健中心机构监测信息网络直报系统,对山西省131所妇幼保健机构2009年的人力资源、设备情况、收支情况等信息资料进行描述。结果:妇幼保健机构人员编制不足,卫生技术人员达标率低;妇幼卫生技术人员素质偏低、结构欠合理;妇幼保健机构特别是基层妇幼保健机构设备落后,后续发展资金剩余不足。结论:①各级妇幼保健机构应合理进行人员配置,合理引进人才;②努力加强妇幼保健队伍人员素质建设;③增加资金投入,改善设备条件。     

Do active patients seek higher quality prenatal care?: A panel data analysis from Nairobi,Kenya

Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these “active” patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the “slums” of) Nairobi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received. We define active antenatal care (ANC) patients as those women who switch ANC providers and explore the prevalence, characteristics and care-seeking behavior of these patients. We analyze whether active ANC patients appear to be seeking out higher quality facilities and whether they are more satisfied with their care. Women in our sample visit over 150 different public and private ANC facilities. Active patients are more educated and more likely to have high risk pregnancies, but have otherwise similar characteristics to non-active patients. We find that active patients are increasingly likely to pay for private care (despite public care being free) and to receive a higher quality of care over the course of their pregnancy. We find that active patients appear more satisfied with their care over the course of pregnancy, as they are increasingly likely to choose to deliver at the facility providing their ANC.     

Texas to switch from codes to names to track HIV cases

The Texas Department of Health is abandoning its unique identifiers tracking program and will begin using names to track HIV cases. Maryland is the only other State using coded numbers for HIV surveillance programs. Texas officials say that health care providers send them many reports with incorrect or abbreviated numbers, making it impossible to eliminate duplicate reports or accurately describe trends in the epidemic or treatment programs. The initial public response to the change has been mixed. Washington and Oregon, with no mandatory HIV reporting process now, are debating policies for case surveillance and may begin using unique identifiers.     

Priority measures for publicly reporting primary care performance: Results of public engagement through deliberative dialogues in 3 Canadian provinces

ObjectiveWhile public reporting of hospital‐based performance measurement is commonplace, it has lagged in the primary care sector, especially in Canada. Despite the increasing recognition of patients as active partners in the health‐care system, little is known about what information about primary care performance is relevant to the Canadian public. We explored patient perspectives and priorities for the public reporting of primary care performance measures.MethodsWe conducted six deliberative dialogue sessions across three Canadian provinces (British Columbia, Ontario, Nova Scotia). Participants were asked to rank and discuss the importance of collecting and reporting on specific dimensions and indicators of primary care performance. We conducted a thematic analysis of the data.ResultsFifty‐six patients participated in the dialogue sessions. Measures of access to primary care providers, communication with providers and continuity of information across all providers involved in a patient''s care were identified as the highest priority indicators of primary care performance from a patient perspective. Several common measures of quality of care, such as rates of cancer screening, were viewed as too patient dependent to be used to evaluate the health system or primary care provider''s performance.ConclusionsOur findings suggest that public reporting aimed at patient audiences should focus on a nuanced measure of access, incorporation of context reported alongside measurement that is for public audiences, clear reporting on provider communication and a measure of information continuity. Participants highlighted the importance the public places on their providers staying up to date with advances in care.     

Benefit-cost analysis of active surveillance of primary care physicians for hepatitis A.

We identified two random samples of 216 primary care physicians each. In one sample, we made weekly telephone contact for active hepatitis A (HA) surveillance; in the other, we made no such contact (passive surveillance). Appropriate county health departments were notified whenever we identified a HA case by active surveillance. Active surveillance was associated with a 2.8-fold increase in reported HA cases compared to passive surveillance. The estimated benefit: cost ratio active/passive surveillance was 2.5:1.     

Comparative quality of private and public health services in rural Vietnam

BACKGROUND: Private health care services were officially recognized in Vietnam in 1989, and for the last 15 years have competed with the public health system in providing primary curative care and pharmaceutical sales to rural populations. However, the quality of these private and public health care services has not been evaluated and compared. METHODS: A community-based survey was conducted in 30 of the 160 communes in Hung Yen, which were selected by probability proportional to population size (PPS) sampling. All commune health centres (CHCs) and private health care providers in the selected communes were surveyed on human resources, services provided, availability of medical equipment and pharmaceuticals, knowledge and clinical performance for acute and chronic problems. Patient satisfaction and cost of care associated with recent illness were measured using a random household survey covering 30 households from each of the selected communes. RESULTS: There were 11.5 private providers per 10,000 population, compared with 6.7 public providers per 10,000. A quarter of private providers were employees of the public health sector. Less than 20% of the private providers had registered their practice with the government system. Eleven per cent (26/234) had no professional qualifications. Fifty-eight per cent (135/234) provided treatment as well as selling medications. Public sector infrastructure was superior to that of the private providers. The quality of services provided by public providers was poor but significantly better than that of private providers. Patient satisfaction and costs of care were similar between the two groups. CONCLUSIONS: Private providers are successfully competing with the public health centre system in rural areas but not because they provide cheaper or better services. The quality of private health care services is not controlled and is significantly poorer than public services. Current practice in both systems falls below the national standard, especially for the management of chronic health problems. The low quality of health care services at a community level may help explain the previously observed phenomena of high levels of self-medicating, low utilization of commune health centres and over-utilization of tertiary health care facilities.