@article{Brannen_Branum_Schmitt_2017, title={Infectious Disease Reporting and Outbreak Management Improvement Project}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7691}, DOI={10.5210/ojphi.v9i1.7691}, abstractNote={<div style="left: 78.2727px; top: 278.962px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.0823);" data-canvas-width="55.467823232323234">Objective</div><div style="left: 91.3182px; top: 291.965px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00134);" data-canvas-width="259.3632045454545">Improve disease reporting and outbreak mangement.</div><div style="left: 78.2727px; top: 319.548px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.11884);" data-canvas-width="71.86668434343434">Introduction</div><div style="left: 91.3182px; top: 332.551px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.996574);" data-canvas-width="329.002305050505">Specific communicable diseases have to be reported by law within</div><div style="left: 78.2727px; top: 347.046px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00339);" data-canvas-width="331.58718939393924">a specific time period. In Ohio, prior to 2001, most of these disease</div><div style="left: 91.3182px; top: 361.541px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00028);" data-canvas-width="329.2092929292928">reports were on paper reports that were reported from providers to</div><div style="left: 78.2727px; top: 376.036px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03105);" data-canvas-width="343.1859030303029">local health departments. In turn the Communicable Disease Nurse</div><div style="left: 78.2727px; top: 390.531px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.977927);" data-canvas-width="343.96950000000004">mailed the hardcopies to the Ohio Department of Health (ODH).</div><div style="left: 78.2727px; top: 405.026px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.978543);" data-canvas-width="341.78873484848475">In 2001 the Ohio Disease Reporting System (ODRS) was rolled out to</div><div style="left: 78.2727px; top: 419.521px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01308);" data-canvas-width="197.68574494949505">all local public health agencies in Ohio.</div><div style="left: 275.949px; top: 419.847px; font-size: 7.39242px; font-family: serif;">1</div><div style="left: 279.645px; top: 419.521px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02297);" data-canvas-width="141.25444242424243">ODRS is Ohio’s portion of</div><div style="left: 78.2727px; top: 434.016px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01669);" data-canvas-width="342.9111512626263">the National Electronic Disease Surveillance System. ODRS should</div><div style="left: 78.2727px; top: 448.511px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.972689);" data-canvas-width="343.79701010101">not be confused with syndromic surveillance systems that are for</div><div style="left: 78.2727px; top: 463.006px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.977144);" data-canvas-width="335.66534343434324">detecting a disease outbreak before the disease itself is detected.</div><div style="left: 413.758px; top: 463.332px; font-size: 7.39242px; font-family: serif;">2</div><div style="left: 78.2727px; top: 477.501px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.995582);" data-canvas-width="344.388404040404">Chronic disease surveillance system data has been evaluated for</div><div style="left: 78.2727px; top: 491.996px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02603);" data-canvas-width="229.30067929292923">long term trends and potential enhancements.</div><div style="left: 307.612px; top: 492.321px; font-size: 7.39242px; font-family: serif;">3</div><div style="left: 311.332px; top: 491.996px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04996);" data-canvas-width="110.00050479797981">However, the use of</div><div style="left: 78.2727px; top: 506.491px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.98118);" data-canvas-width="343.4618868686869">communicable disease reports vary greatly.4 However, the export</div><div style="left: 78.2727px; top: 520.985px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03441);" data-canvas-width="342.90622297979814">data has not routinely been used for quality improvement purposes</div><div style="left: 78.2727px; top: 535.48px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.964969);" data-canvas-width="343.68981994949485">of the disease reporting process itself. In December 2014, Greene</div><div style="left: 78.2727px; top: 549.975px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00605);" data-canvas-width="342.44419646464644">County Public Health (GCPH) begain a project to improve reporting</div><div style="left: 78.2727px; top: 564.47px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0013);" data-canvas-width="319.9318005050504">of communicable diseases and the response to disease outbreaks.</div><div style="left: 78.2727px; top: 592.053px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.07424);" data-canvas-width="50.65042676767676">Methods</div><div style="left: 91.3182px; top: 605.056px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.989435);" data-canvas-width="331.22988888888875">Initial efforts were to understand the current disease reporting</div><div style="left: 78.2727px; top: 619.551px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.977374);" data-canvas-width="343.40028333333356">process: Quantitative management techniques including creating a</div><div style="left: 78.2727px; top: 634.046px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02316);" data-canvas-width="343.0134131313131">logic model and process map of the existing process, brainstorming</div><div style="left: 78.2727px; top: 648.541px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01175);" data-canvas-width="344.80607601010087">and ranking of issues. The diseases selected to study included:</div><div style="left: 78.2727px; top: 663.036px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0502);" data-canvas-width="347.8246492424242">Campylobacteriosis, Cryptosporidiosis, E. coli O157:H7 &</div><div style="left: 78.2727px; top: 677.531px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.05537);" data-canvas-width="345.87920959595954">shiga toxin-producing E. coli, Giardiasis, Influenza-associated</div><div style="left: 78.2727px; top: 692.026px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03989);" data-canvas-width="345.398702020202">hospitalization, Legionnaires’ disease, Pertussis, Salmonellosis,</div><div style="left: 78.2727px; top: 706.521px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.960003);" data-canvas-width="343.569077020202">and Shigellosis. The next steps included creating a data collection</div><div style="left: 78.2727px; top: 721.016px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.986806);" data-canvas-width="344.4118133838383">and analysis plan. An updated process map was created and the</div><div style="left: 78.2727px; top: 735.511px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0086);" data-canvas-width="344.77281010100984">pre- and post-process maps were compared to identify areas to</div><div style="left: 78.2727px; top: 750.006px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.973095);" data-canvas-width="343.59987878787877">improve. The median number of days were compared before and</div><div style="left: 78.2727px; top: 764.501px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.963289);" data-canvas-width="343.42862095959583">after improvements were implemented. Modeling of the impact of</div><div style="left: 78.2727px; top: 778.996px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.95658);" data-canvas-width="343.3325194444441">the process improvements on the median number of days reported</div><div style="left: 78.2727px; top: 793.491px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.024);" data-canvas-width="342.9542737373736">was conducted. Estimation of the impact in healthy number of days</div><div style="left: 78.2727px; top: 807.985px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00116);" data-canvas-width="338.04323989898967">derived from the reduction in days to report (if any) were calculated.</div><div style="left: 78.2727px; top: 835.568px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.08542);" data-canvas-width="44.50239393939395">Results</div><div style="left: 91.3182px; top: 848.571px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01515);" data-canvas-width="331.69930782828266">Process improvements identified: Ensure all disease reporters</div><div style="left: 78.2727px; top: 863.066px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00739);" data-canvas-width="344.32556843434367">use digital reporting methods preferably starting with electronic</div><div style="left: 78.2727px; top: 877.561px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02699);" data-canvas-width="343.23641792929294">laboratory reporting directly to the online disease reporting system,</div><div style="left: 78.2727px; top: 892.056px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00476);" data-canvas-width="342.3554873737371">with other methods such as direct web data entry into system, faxing</div><div style="left: 78.2727px; top: 906.551px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00132);" data-canvas-width="68.77418686868687">lab reports, or</div><div style="left: 91.3182px; top: 921.046px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01372);" data-canvas-width="331.62168737373736">secure emailing reports, with no or little hard copy mailing;</div><div style="left: 78.2727px; top: 935.541px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.9796);" data-canvas-width="341.79859141414136">Centralize incoming email and fax reports (eliminating process steps);</div><div style="left: 78.2727px; top: 950.036px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.969681);" data-canvas-width="343.153869191919">Standardize backup staffing procedures for disease reporting staff;</div><div style="left: 78.2727px; top: 964.531px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.992566);" data-canvas-width="341.9057815656566">Formalize incident command procedures under the authorized person</div><div style="left: 78.2727px; top: 979.026px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00671);" data-canvas-width="342.44912474747474">in charge for every incident rather than distribute command between</div><div style="left: 78.2727px; top: 993.521px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.992558);" data-canvas-width="341.9033174242424">environmental and clinical services; and place communicable disease</div><div style="left: 78.2727px; top: 1008.02px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.99386);" data-canvas-width="342.02036414141406">reporting under that single authority rather than clinical services. The</div><div style="left: 78.2727px; top: 1022.51px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03586);" data-canvas-width="343.0602318181819">days to report diseases were reduced from a median of 2 to .5 days</div><div style="left: 78.2727px; top: 1037.01px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00697);" data-canvas-width="342.48855101010093">(p<.001). All the diseases were improved except for crytosporodium</div><div style="left: 78.2727px; top: 1051.5px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.990079);" data-canvas-width="344.2011292929292">due to an outlier report two months late. The estimated societal</div><div style="left: 443.545px; top: 277.47px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02712);" data-canvas-width="342.9542737373737">healthy days saved were valued at $52,779 in the first eight months</div><div style="left: 443.545px; top: 291.965px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00145);" data-canvas-width="211.1399570707071">after implementation of the improvements.</div><div style="left: 443.545px; top: 319.548px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.10408);" data-canvas-width="73.93656313131314">Conclusions</div><div style="left: 456.591px; top: 332.551px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.969023);" data-canvas-width="330.5497858585858">Improvements in disease reporting decreased the reporting time</div><div style="left: 443.545px; top: 347.046px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04532);" data-canvas-width="342.9702906565659">from over 2 days to less than 1 day on average. Estimated societal</div><div style="left: 443.545px; top: 361.541px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.974628);" data-canvas-width="343.84875707070717">healthy days saved by this project during the first 9 months was</div><div style="left: 443.545px; top: 376.036px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.964474);" data-canvas-width="343.51363383838395">$52,779. Management of early command and control for outbreak</div><div style="left: 443.545px; top: 390.531px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00142);" data-canvas-width="118.73465404040405">response was improved.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Brannen, Donald E. and Branum, Melissa and Schmitt, Amy}, year={2017}, month={May} }