Ambulatory Care

Syndromic surveillance is one of the meaningful use public health menu set objectives for eligible professionals. The value of this data for syndromic surveillance as an adjunct to the more widely adopted emergency department registrations has not been studied extensively. It may be that it would improve the sensitivity or timeliness of detecting certain communicable disease events, or it may just contain signals comparable to what is available via other syndromic surveillance data streams. The value of making the effort to collect this data is considered contingent on the answer to that question.

Public health is concerned with more than just communicable diseases, however. Chronic diseases and their underlying causes are also a significant public health concern. Obesity alone is estimated to be responsible for 2.5% of the global disease burden, and represents a higher fraction in many developed nations. Since chronic diseases are not associated with singular events of brief duration, they are difficult to track with traditional surveillance methods. They are also not typically managed via emergency departments, so syndromic surveillance does not capture them well either.

Chronic diseases are often treated by physicians at ambulatory practices. Thus data from eligible professionals may provide a means for monitoring chronic diseases, or metrics associated with chronic diseases, that would not otherwise be as feasible. As a proof of concept, this study seeks to determine if body mass index (BMI), the standard measure of obesity, can be obtained from ambulatory syndromic surveillance messages.

Objective

To demonstrate the utility of ambulatory syndromic surveillance data to public health domains beyond communicable diseases

The North Dakota Department of Health (NDDoH) collects outpatient ILI data through North Dakota Influenza-like Illness Network (ND ILINet), providing situational awareness regarding the percent of visits for ILI at sentinel sites across the state. Because of increased clinic staff time devoted to electronic health initiatives and an expanding population, we have found sentinel sites have been harder to maintain in recent years, and the number of participating sentinel sites has decreased. Outpatient sentinel surveillance for influenza is an important component of influenza surveillance because hospital and death surveillance does not capture the full spectrum of influenza illness. Syndromic surveillance (SyS) is another possible source of information for outpatient ILI that can be used for situational awareness during the influenza season; one benefit of SyS is that it can provide more timely information than traditional outpatient ILI surveillance [1,2]. The NDDoH collects SyS data from hospitals (emergency department and inpatient visits) and outpatient clinics, including urgent and primary care locations. Visits include chief complaint and/or diagnosis code data. This data is sent to the BioSense 2.0 SyS platform. We compared our outpatient SyS ILI with our ND ILINet and reported influenza cases, and included hospital and combined SyS ILI for comparison.

Objective

To explore how outpatient and urgent care syndromic surveillance for influenza-like illness (ILI) compare with emergency department syndromic ILI and other seasonal ILI surveillance indicators

Data submitted to ILINet from ambulatory practices are a primary feature of influenza-like illness (ILI) surveillance in the United States. Practices count relevant patient records and submit this data manually to ILINet. The ongoing data collection is useful for surveillance, and a significant amount of historical data has accumulated which is useful for research purposes and comparisons of the present season to the past. However, the tabulation of this data is costly, and retention of sentinel practices can be challenging as there is no mandate to submit data. Increasingly, the EpiCenter syndromic surveillance system is receiving data from ambulatory practices. Syndromic surveillance data is sent automatically in near-realtime. Meaningful Use requirements incentivize practices to participate in ongoing data transmission. Syndromic surveillance data from ambulatory practices is thus a possible substitute for the current, more labor-intensive surveillance of ambulatory practices.

Objective

To investigate the viability of using prediagnostic syndromic surveillance data from ambulatory practices for influenza-like illness surveillance

From 1 September 2015, babies in the United Kingdom (UK) born on/after 1 July 2015 became eligible to receive the MenB vaccine, given at 2 and 4 months of age, with a booster at 12 months. Early trials found a high prevalence of fever (over 38°C) in babies given the vaccine with other routine vaccines at 2 and 4 months. We used syndromic surveillance data to assess whether there had been increased family doctor (general practitioner (GP)) consultations for fever in young infants following the introduction of the vaccine. 

Objective

To use syndromic surveillance data to assess whether there has been an increase in GP fever consultations since the inclusion of the meningococcal B (MenB) vaccine in the UK vaccination schedule. 

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.