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Evaluation of Public Health Surveillance Systems.


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Evaluation of Public Health Surveillance Systems. CDC/CSTE Applied Epidemiology Fellowship Program Orientation 2009 Sam Groseclose, DVM, MPH Division of STD Prevention, NCHHSTP, CCID sgroseclose@cdc.gov Phone: 404-639-6494. Objectives.
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Assessment of Public Health Surveillance Systems CDC/CSTE Applied Epidemiology Fellowship Program Orientation 2009 Sam Groseclose, DVM, MPH Division of STD Prevention, NCHHSTP, CCID sgroseclose@cdc.gov Phone: 404-639-6494

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Objectives Review ventures in arranging & directing reconnaissance framework assessment Describe observation framework characteristics that ought to be surveyed or measured Describe how assessment of reconnaissance framework for flare-up discovery varies from one for individual cases

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"General wellbeing reconnaissance is the progressing, orderly gathering, examination, translation, and dispersal of information in regards to a wellbeing related occasion for use in general wellbeing activity to diminish bleakness and mortality and to enhance wellbeing." CDC. Upgraded rules for assessing general wellbeing reconnaissance frameworks. MMWR 2001;50 (No. RR-13)

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"General wellbeing observation is the continuous, orderly accumulation, examination, understanding, and dispersal of information with respect to a wellbeing related occasion for use in general wellbeing activity to diminish dreariness and mortality and to enhance wellbeing." CDC. Redesigned rules for assessing general wellbeing reconnaissance frameworks. MMWR 2001;50 (No. RR-13)

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Why assess an observation framework? Are destinations being met? Is result under observation still of general wellbeing significance? Is checking productive & compelling? Are destinations still pertinent?

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When to assess an observation framework? Reaction to changes in… Priorities Information needs Epidemiology Diagnostic techniques Clinical practices Data sources

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Rubella occurrence – noteworthy lows half rubella contaminations – asymptomatic Is endemic transmission hindered in U.S.? Averhoff et al CID 2006

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How might you survey ampleness of rubella reconnaissance?

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Evaluation strategies: Survey: state & nearby wellbeing office Rubella & measles observation rehearses, e.g., # measles flare-up examinations Survey: state & neighborhood general wellbeing labs Lab testing hones Enhanced assessment: CA, NYC, US-Mexico Border ID Surveillance Project Sentinel reconnaissance: HMO-based

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Are measles or rubella examinations happening? Is corroborative lab testing being directed? Averhoff et al CID 2006

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Which wards are directing rubella examinations? Averhoff et al CID 2006

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Conclusions: No new cases discovered  Sufficient affectability of reconnaissance. Rubella reconnaissance "rides the coattails" of measles and other rash ailment observation upgrading affectability. Averhoff et al CID 2006

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Evaluation permits proactive reaction to new requests. New epidemiologic discoveries  Revision of case definitions? Information source permits observing of extra wellbeing related occasions? Need > auspiciousness or > productivity?  Use of new data innovation Increasing access to e-information  Protection of patient protection, information secrecy, & framework security Other…

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CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems, 2001

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CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems, 2001 Based on: CDC's Framework for Program Evaluation in Public Health. MMWR 1999;48(RR-11) – under update. CDC's Guidelines for assessing reconnaissance frameworks . MMWR 1988;37(No. S-5) Need for incorporating observation & wellbeing data frameworks Increasing importance of informatics: Establishing information norms Electronically trading wellbeing information Facilitating reaction to rising wellbeing dangers Addressed:

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Examples of other direction on general wellbeing reconnaissance checking & assessment

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Tasks in CDC's upgraded rules Engage partners Describe framework Focus assessment outline Gather confirmation of framework's execution State conclusions & make proposals Ensure utilization of discoveries & offer lessons learned

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Task A. Draw in partners Who are the framework partners? Which ones ought to be included? Scope, level, & type of partner association will change Influence outline? Give information? Help translation? Execute proposals?

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Stakeholder ID & engagement Ask your director Who is financing the framework? Who utilizes data got from framework? Does political/hierarchical environment permit them to impact assessment? How to lock in? Meeting – create questions early Survey – more organized, more partners, more significant in the event that they are "dynamic"

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Task B. Depict framework Public wellbeing significance Purpose, targets, & operation Planned utilization of information Case definition Population under reconnaissance Legal power System stream graph Roles & duties Inputs & yields Resources

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Public wellbeing significance: Should this occasion be under observation? Lists of recurrence or weight Case number? Frequency rate? Outline measures of populace wellbeing status Disability-balanced life-years? Files of seriousness Case-casualty rate? Hospitalization rate? Variations or imbalances related? Preventability?

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Public wellbeing significance: Information sources? Topic specialists Surveillance & research information Literature survey Other…

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Surveillance framework reason Why does the framework exist? Case: To screen " X wellbeing condition " in " Population under observation "

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Surveillance framework goals How are the information to be utilized for general wellbeing activity? Screen weight or patterns Identify populaces at expanded danger Support early discovery Inform hazard administration & basic leadership Evaluate intercessions or arrangement Other…

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Example: Objectives for Australian National Notifiable Disease Surveillance System (NNDSS) Miller et al. Comm Dis Intell , 2004

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Example: Australian NNDSS forms Miller et al. Commun Dis Intell , 2004

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Example: Legislative power: Australian NNDSS No administrative prerequisite for states and regions to send notifiable malady information to the Commonwealth. Mill operator et al. Commun Dis Intell , 2004

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Resources Direct costs Person-time every year IT equipment/programming Travel Training Indirect costs Follow-up analytic lab testing Case administration Outbreak reaction Prevention benefits/costs from societal point of view Cost of missing flare-ups Productivity misfortunes turned away

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Example: Resources Direct costs just Cost by framework stage Kirkwood et al. J Public Hlth Mngmnt Practice , 2007

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Task C. Center assessment plan Specific motivation behind the assessment CSTE cooperation as it were? General wellbeing destinations? Reaction to wellbeing framework change? Partner's information (Task An) Identify questions that will be addressed How will data produced be utilized? Would you be able to characterize "relative" execution benchmarks' measurements for traits from the earlier ? What's satisfactory?

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Usefulness? What moves made in view of information from framework? Meet framework destinations? Framework traits Simplicity Flexibility Data quality Acceptability Sensitivity Predictive worth positive (PVP/PPV) Representativeness Timeliness Stability Task D. Assemble confirmation of framework's execution

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Task E. State conclusions and make proposals Conclusions Important general wellbeing issue? Framework's goals met? Suggestions Modification/continuation? Consider interdependencies between framework costs & characteristics Ethical commitments Surveillance being directed dependably?

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Example : Evaluation conclusions Jhung et al. Restorative consideration , 2007

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Task F. Guarantee utilization of discoveries and offer lessons learned Deliberate push to utilize results & disperse discoveries? Earlier talk of reaction to possibly negative discoveries? Earlier arrangement to execute suggestions in view of discoveries? Systems for conveying discoveries? Tailor content & strategy to pertinent audience(s)

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"The explanation behind gathering, investigating and spreading data on an illness is to control that ailment. Gathering and investigation ought not be permitted to devour assets if activity does not take after. " Foege WH et al. Int J Epidemiology 1976 Similarly, assessment discoveries ought to be connected for observation change.

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Usefulness? What moves made in light of information from framework? Meet framework goals? Framework traits Simplicity Flexibility Data quality Acceptability Sensitivity Predictive worth positive (PVP/PPV) Representativeness Timeliness Stability Task D. Assemble confirmation of framework's execution

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Example: Usefulness from general wellbeing framework point of view Miller et al. Transferable Disease Intelligence , 2004

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Example: Usefulness from outside partner point of view Miller et al. Transmittable Disease Intelligence , 2004

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Have your reconnaissance endeavors brought about any of these results? WHO/CDS/CSR/LYO/2004.15

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Usefulness? What moves made in view of information from framework? Meet framework destinations? Framework traits Simplicity Flexibility Data quality Acceptability Sensitivity Predictive worth positive (PVP/PPV) Representativeness Timeliness Stability Task D. Assemble proof of framework's execution

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Timeliness Different scales in light of result & activity Meningococcal meningitis >> growth If auspiciousness is basic: Active reconnaissance Acquire electronic records Encourage phone provides details regarding suspicion Educate clinicians and lab staff Review as much of the time as the information arrive Remove hindrances to incite reporting Adjust venture to significance

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When measuring opportuneness, determine the typ