Medicaid

The New York State (NYS) Medicaid Program provides healthcare for 34% of the population in New York City (NYC) and 4%-20% in each of the 57 county populations up-state. Prescription data are collected through the sub-mission of claims forms to the Medicaid Program and transmitted daily to the NYS Syndromic Surveillance Program as summary counts by drug category and patient’s ZIP Code, age category, and sex. One of the 18 drug categories is influenza agents, which in-cludes rimantadine, oseltamivir, and zanamivir.

For surveillance of influenza-like illness (ILI) activity, the NYS and NYC Sentinel Physician Influenza Surveillance Program collects from sentinel physicians weekly reports of the total number of patients seen and the number of patients presenting with ILI (defined as temperature > 100 degrees F, presence of cough or sore throat, and absence of other known cause of these symptoms). Not all counties in NYS have sentinel physicians: in the 2003-2004 flu surveillance season (Week 40, in early October, 2003, to Week 20, in late May, 2004), 37 of 57 upstate counties and all 5 counties of NYC had sentinel physicians.

Objective

To evaluate the usefulness of daily counts of prescriptions for influenza agents charged to Medicaid insurance, by county of residence of the recipient, for detection of elevated ILI in NYS, currently monitored through physicians participating in the CDC Influenza Surveillance Program.

The New York State Department of Health (NYSDOH) Syndromic Surveillance System consists of five components: 1. Emergency Department (ED) Phone Call System monitors unusual events or clusters of illnesses in the EDs of participating hospitals; 2. Electronic ED Surveillance System monitors ED chief complaint data; 3. Medicaid data system monitors Medicaid-paid over-the-counter and prescription medica-tions; 4. National Retail Data Monitor/Real-time Outbreak and Disease Surveillance System monitors OTC data; 5. CDC’s BioSense application monitors Department of Defense and Veterans Administration outpatient care clinical data (ICD-9-CM diag-noses and CPT procedure codes), and LabCorp test order data.

Objective

This poster presentation provides an overview of the NYSDOH Syndromic Surveillance System, including data sources, analytic algorithms, and resulting reports that are posted on the NYSDOH Secure Health Commerce System for access by state, regional, county, and hospital users.

As a part of the Zika Birth Defects Surveillance, a national effort coordinated by the Centers for Disease Control and Prevention (CDC), NYC is conducting enhanced surveillance of all births with defects included in the congenital Zika syndrome (CZS) phenotype among infants born in NYC beginning in 2016. The intent of the project is to provide background on the prevalence of these conditions, regardless of cause. The surveillance project builds on the New York State (NYS) Congenital Malformations Registry, a passive, mandatory reporting system that relies on reporting from hospitals and providers. For the Surveillance project, potential cases of Zika-related birth defects (ZBD) are identified by hospital and administrative data of birth records with one or more of the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes associated with CZS.1 The list of included diagnostic codes was specified by the NYS registry following guidance established by CDC. Full medical record chart abstraction of the birth hospital visit of potential cases is then conducted applying further inclusion guidelines to identify ZBD cases. Recent reports of late presentation of birth defects consistent with CZS suggest that some cases are being missed due to identification and diagnosis of the condition after birth.2 As one component of a broader strategy to obtain a more accurate surveillance count, we seek to identify potential ZBD cases first diagnosed in the 6-month postpartum period using Medicaid claims data.

Objective:

To assess the use of Medicaid claims data to conduct surveillance for cases of Zika-related birth defects identified after birth among infants born in New York City (NYC).