Lucero-Obusan Cynthia

VA began using ESSENCE as a public health surveillance tool in 2005. The system offered alerting capability for pre-defined syndromes and querying capability for outpatient ICD-9 diagnosis codes. Herein, we highlight examples of how we have invested in upgrades to analytic capabilities and expanded data sources available to ESSENCE in order to augment the overall utility of this system within VA.

Objective

To describe VA’s experience developing innovative and alternative uses of a surveillance system and improve the overall value proposition of this tool for the agency.

DENV, CHIKV and ZIKV are all transmitted by mosquitoes and have occurred in outbreaks in the Caribbean. Common symptoms (which can be severe and disabling) are similar among the 3 viruses and include fever, joint pain/swelling, headache, muscle pain and rash. In December 2015, the first endemic case of ZIKV infection was reported by VACHS. Since that time, an increasing number of ZIKV infections have been reported in Puerto Rico. Due to the growing ZIKV outbreak, we performed ongoing testing and surveillance.

Objective

We describe surveillance for Dengue virus (DENV), Chikungunya virus (CHIKV) and Zika virus (ZIKV) in VA Caribbean Healthcare System (VACHS) from the start of ZIKV transmission in Puerto Rico.

Many methods to detect outbreaks currently exist, although most are ineffective in the face of real data, resulting in high false positivity. More complicated methods have better precision, but can be difficult to interpret and justify. Praedico™ is a next generation biosurveillance application built on top of a Hadoop High Performance Cluster that incorporates multiple syndromic surveillance methods of alerting, and a machine-learning (ML) model using a decision tree classifier  evaluating over 100 different signals simultaneously, within a user friendly interface.

Objective

To compare syndromic surveillance alerting in VA using Praedico™ and ESSENCE.

It is estimated that in the United States (US), unintentional non-fire related CO poisoning causes an average of 439 deaths annually, and in 2007 confirmed CO poisoning cases resulted in 21,304 ED visits and 2,302 hospitalizations (71 per million and 8 per million population, respectively)1 . Despite the significant risk of morbidity and mortality associated with CO poisoning, existing surveillance systems in the United States are limited. This study is the first to focus specifically on CO poisoning trends within the VHA population.

Objective

To describe characteristics of Veterans Health Administration (VHA) patients with ICD 9/10 CM inpatient discharge and/or emergency department (ED)/urgent care outpatient encounter codes for carbon monoxide (CO) poisoning.

Firearm violence is an issue of public health concern leading to more than 30,000 deaths and 80,000 nonfatal injuries in the United States annually. To date, firearm-related studies among Veterans have focused primarily on suicide and attempted suicide. Herein, we examine firearm violence among VHA enrollees for all manners/ intents, including assault, unintentional, self-inflicted, undetermined and other firearm-related injury encounters in both the inpatient and outpatient settings.