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Discharge Diagnosis

Description

ESSENCE is a web-based syndromic surveillance system utilized by DHMH to detect and track outbreaks, suspicious patterns of illness, public health emergencies, and biological threats. ESSENCE ED chief complaint data is collected daily from 47 emergency departments in Maryland (all 45 acute care hospitals and 2 freestanding emergency medical facilities). A chief complaint in ESSENCE is a free text field that lists the patient’s reason for the ED visit upon arrival at the hospital. Chief complaint data may be comprehensive or abbreviated and may include a single reason or multiple reasons for the ED visit. Medical history may be included in chief complaint data, which can create low specificity (false positive cases). Chief complaint data alone may yield less accurate modeling and lower outbreak detection sensitivity. This analysis evaluates whether counts of chief complaints are appropriate indicators of disease burden for several specific illnesses, by comparing chief complaints to their corresponding discharge diagnoses.

Objective

The state of Maryland has incorporated chief complaint data from 100% of its acute care emergency departments (ED) into the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE). In 2012, the Maryland Department of Health and Mental Hygiene (DHMH) began using this statewide disease surveillance system to track several specific disease measures including certain chronic diseases. The validity of using ESSENCE ED data to track and analyze these health outcomes was evaluated.

Submitted by knowledge_repo… on
Description

The Electronic Surveillance System for the Early Notification of Community-based Epidemics in Florida (ESSENCE-FL) is a web-based application for use by public health professionals within the Florida Department of Health (FDOH). The main source of data for ESSENCE-FL is emergency department (ED) data. Ten hospitals in Hillsborough County, Florida send their data to the ESSENCE-FL server. ESSENCE-FL requires only a limited data set to be sent by the hospital which includes patient chief complaint (CC) and discharge diagnosis (DD). These fields can be searched individually, in separate queries, to identify possible records of interest. These two fields have been concatenated to create the single chief complaint and discharge diagnosis (CCDD) field, allowing both fields to be searched with a single query.

Objective

While syndromic surveillance systems were originally designed for the detection of outbreaks and clusters of illness, they have been found to be useful at identifying unreported conditions of public health importance. Within the Florida Department of Health in Hillsborough County (FDOH-Hillsborough), these conditions of public health importance have primarily focused on the reportable diseases and conditions that fall under the responsibility of the Epidemiology Program and have not included tuberculosis. A specific query has been developed to search for and identify possible tuberculosis patients and exposed contacts. This study is designed to determine the usefulness of specific-term chief complaint and discharge diagnosis (CCDD) queries in identifying tuberculosis patients and exposed contacts.

Submitted by knowledge_repo… on
Description

The BioSense system receives patient level clinical data from > 370 hospitals and 1100 ambulatory care Departments of Defense and Veterans Affairs medical facilities. Visits are assigned as appropriate to 78 sub-syndromes, including respiratory syncytial virus (RSV). Among infants and children < 1 year of age, RSV is the most common cause of bronchiolitis and pneumonia; 0.5% to 2% require hospitalization. Increasingly, RSV is also recognized as a major cause of pneumonia in elderly adults.

 

Objective

To analyze final diagnosis data available to BioSense and determine its potential utility for surveillance of RSV illness.

Submitted by elamb on
Description

Syndromic surveillance aims to decrease the time to detection of an outbreak compared to traditional surveillance methods. Emergency department (ED) syndromic surveillance systems vary in their methodology and complexity and are usually based on presenting chief complaints. Prior work in ED-based syndromic surveillance has shown conflicting results on agreement between chief complaint and discharge diagnosis, which may be syndrome-dependent. The use of ED discharge diagnosis may improve surveillance validity if it can be done in a timely fashion.

Objective 

The purpose of this study is to characterize the relationship of emergency department chief complaint and final primary ICD-9 diagnosis assigned at the time of emergency department disposition for patients with symptoms and/or ICD-9 codes associated with influenza like illness (ILI) using an electronic medical record.

Submitted by elamb on

Arizona reports an average of 116 cases of West Nile virus (WNV) each year, and in 2015, Arizona saw a reemergence of St. Louis encephalitis (SLE) virus. In addition, Arizona is at risk for importation of viruses such as chikungunya, dengue, and Zika due to an abundance of Aedes aegypti mosquitoes in many parts of the state. Rapid identification of potential cases of arboviral disease (borne by mosquitoes and ticks) is critical to implementing appropriate public health responses.

Submitted by elamb on
Description

Indiana utilizes the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) to collect and analyze data from participating hospital emergency departments. This real-time collection of health related data is used to identify disease clusters and unusual disease occurrences. By Administrative Code, the Indiana State Department of Health (ISDH) requires electronic submission of chief complaints from patient visits to EDs. Submission of discharge diagnosis is not required by Indiana Administrative Code, leaving coverage gaps. Our goal was to identify which areas in the state may see under reporting or incomplete surveillance due to the lack of the discharge diagnosis field.

Objective:

To identify surveillance coverage gaps in emergency department (ED) and urgent care facility data due to missing discharge diagnoses.

Submitted by elamb on
Description

The Georgia DPH has used its State Electronic Notifiable Disease Surveillance System (SendSS) Syndromic Surveillance (SS) module to collect, analyze and display analyses of ED patient visits, including DDx data from hospitals throughout Georgia for early detection and investigation of cases of reportable diseases before laboratory test results are available. Evidence on the value of syndromic surveillance approaches for outbreak or event detection is limited. Use of the DDx field within datasets, specifically as it might be used for investigation of outbreaks, clusters, and / or individual cases of reportable diseases, has not been widely discussed.

Objective:

To describe how the Georgia Department of Public Health (DPH) uses ICD-9 and ICD-10-based discharge diagnoses (DDx) codes assigned to Emergency Department (ED) patients to support the early detection and investigation of outbreaks, clusters, and individual cases of reportable diseases.

Submitted by elamb on
Description

The National Syndromic Surveillance Program (NSSP) is a community focused collaboration among federal, state, and local public health agencies and partners for timely exchange of syndromic data. These data, captured in nearly real time, are intended to improve the nation's situational awareness and responsiveness to hazardous events and disease outbreaks. During CDC’s previous implementation of a syndromic surveillance system (BioSense 2), there was a reported lack of transparency and sharing of information on the data processing applied to data feeds, encumbering the identification and resolution of data quality issues. The BioSense Governance Group Data Quality Workgroup paved the way to rethink surveillance data flow and quality. Their work and collaboration with state and local partners led to NSSP redesigning the program’s data flow. The new data flow provided a ripe opportunity for NSSP analysts to study the data landscape (e.g., capturing of HL7 messages and core data elements), assess end-to-end data flow, and make adjustments to ensure all data being reported were processed, stored, and made accessible to the user community. In addition, NSSP extensively documented the new data flow, providing the transparency the community needed to better understand the disposition of facility data. Even with a new and improved data flow, data quality issues that were issues in the past, but went unreported, remained issues in the new data. However, these issues were now identified. The newly designed data flow provided opportunities to report and act on issues found in the data unlike previous versions. Therefore, an important component of the NSSP data flow was the implementation of regularly scheduled standard data quality checks, and release of standard data quality reports summarizing data quality findings.

Objective:

Review the impact of applying regular data quality checks to assess completeness of core data elements that support syndromic surveillance.

Submitted by elamb on