The existing New York State Department of Health emergency department syndromic surveillance system has used patientâs chief complaint (CC) for assigning to six syndrome categories (Respiratory, Fever, Gastrointestinal, Neurological, Rash, Asthma). The sensitivity and specificity of the CC computer algorithms that assign CC to syndrome categories are determined by using chart review as the criterion standard. These analyses are used to refine the algorithm and to evaluate the effect of changes in the syndrome definitions. However, the chart review (CR) method is labor intensive and expensive. Using an automated ICD9 code-based assignment as a surrogate for chart review could offer a significant cost reduction in this process and allow us to survey a much larger sample of visits.
ICD-9
Objective To examine sub-syndrome distributions among BioSense emergency department (ED) chief complaint and final diagnosis based data and to observe patterns by hospital system, age, and gender.
Facing public health threats of bioterrorism and emerging infectious diseases (EID), the traditional passive surveillance system is not efficient and outmoded. Evidences reveal that several newly developed syndromic surveillance system (SSS) in different countries can provide an active, powerful, timely, and effective epidemiological investigation. Using this SSS, we can find non-specific symptoms, and set up baseline clinical data and epidemic threshold. Due to English barriers and standardized language problem in the past, we initiated to develop an emergency department-based syndromic surveillance system (ED-SSS) using clinical data involving both check-list format chief complaints (CoCo) and International Classification of Diseases, Ninth Revision (ICD-9) that best fit the situations in Taiwan.
Objective
The aims of this study are to set up a SSS for detecting newly EID outbreaks early using more standardized information of triage CoCo of hospital emergency department in metropolitan Taipei City to (1) break through Chinese language barrier; (2) investigate its feasibility to detect influenza like illness (ILI) outbreaks using integrated clinical and epidemiological information installed within information technology system; and (3) compare the sensitivity, specificity, and kappa value of ILI between ICD-9 and CoCo.
Syndromic surveillance systems often classify patients into syndromic categories based on emergency department (ED) chief complaints. There exists no standard set of syndromes for syndromic surveillance, and the available syndromic case definitions demonstrate substantial heterogeneity of findings constituting the definition. The use of fever in the definition of syndromic categories is arbitrary and unsystematic. We determined whether chief complaints accurately represent whether a patient has any of five febrile syndromes: febrile respiratory, febrile gastrointestinal, febrile rash, febrile neurological, or febrile hemorrhagic.
Researchers have demonstrated benefits to identifying and developing interventions for patients that frequently seek healthcare services in the ED. The New Yorker Magazine, recently published an article titled The Hot Spotters, summarizing work being done in the United States to lower medical costs by giving the neediest patients better healthcare (1). In Camden, NJ, Physician Jeffrey Brenner closed his regular practice to focus on Hot Spotter patients (directing resources and brainpower to help their improvement) and measured a 40% reduction in hospital inpatient and ED visits and a 56% medical cost reduction for the first 36 Hot Spotters. A 2008 NH Office of Medicaid Business and Policy (OMBP) outpatient Medicaid ED frequency visit study was conducted, which cited that frequent ED users were more likely to have higher costs and rates of illness or disease than all Medicaid members (2). It was noted that increased prevention and wellness could reduce frequent ED use and increase cost savings (5% of the NH Medicaid population contributed to approximately 38% of ED costs). The NH Division of Public Health Services initiated a pilot project to examine NH Emergency Department (ED) surveillance data to identify high utilizer patients and realize improved health benefits and medical cost reductions.
Objective:
To develop a manageable surveillance methodology to detect Emergency Department (ED) patients with the highest healthcare utilization, and monitor their targeted treatment improvement and medical health cost reductions over time for overall improvements in statewide health.
Lack of access to regular dental care often results in costly, oral health visits to EDs that could otherwise have been prevented or managed by a dentist (1). Most studies on oral health-related visits to EDs have used a wide range of classifications from different databases, but none have used syndromic surveillance data. The volume, frequency, and included details of syndromic data enabled timely burden estimates of nontraumatic oral health visits for NC EDs.
Objective:
To develop a nontraumatic oral health classification that could estimate the burden of oral health-related visits in North Carolina (NC) Emergency Departments (EDs) using syndromic surveillance system data.
The NJ syndromic surveillance system, EpiCenter, developed an algorithm to quantify HRI visits using chief complaint data. While heat advisories are released by the National Weather Service, an effective HRI algorithm could provide real-time health impact information that could be used to provide supplemental warnings to the public during a prolonged heat wave.
Objective:
The purpose of this evaluation is to characterize the relationship between a patient’s initial hospital emergency room chief complaint potentially related to a heat-related illness (HRI) with final primary and secondary ICD-9 diagnoses.
Telephone triage is a relatively new data source available to biosurveillance systems.1-2Because early detection and warning is a high priority, many biosurveillance systems have begun to collect and analyze data from non-traditional sources [absenteeism records, overthe-counter drug sales, electronic laboratory reporting, internet searches (e.g. Google Flu Trends) and TT]. These sources may provide disease activity alerts earlier than conventional sources. Little is known about whether VA telephone program influenza data correlates with established influenza biosurveillance.
Objective:
To evaluate the utility and timeliness of telephone triage (TT) for influenza surveillance in the Department of Veterans Affairs (VA).
Surveillance to track the incidence, prevalence and treatment of disease is a fundamental task of public health. The advent of universal health care coverage in the United States and electronic health records could make the medical record a valuable disease surveillance tool. This can only happen, however, if the necessary data can be extracted from the medical record without manual review.
Objective
The objective of this project was to identify criteria that accurately categorize acute coronary and heart failure events exclusively with electronic health record data so that the medical record can be used for surveillance without manual record review.
Special event driven syndromic surveillance is often initiated by public health departments with limited time for development of an automated surveillance framework, which can result in heavy reliance on frontline care providers and potentially miss early signs of emerging trends. To address timelines and reliability issues, automated surveillance system are required.
Objective
To develop and implement a framework for special event surveillance using GUARDIAN, as well as document lessons learned postevent regarding design challenges and usability.