|
| ||||||||
| ||||||||
|
Biosecurity Briefing
RAND: Staffed Disease Reporting Systems are Critical for Timely, Consistent Reports By Michelle Cantu, January 11, 2008 On January 2, 2008, RAND Corporation announced its study, “Measuring the Performance of Telephone-Based Disease Surveillance Systems in Local Health Departments,”1 published early online in the American Journal of Public Health, February edition.2 RAND tested a sample of telephone-based disease surveillance systems (TBDS) in local health departments “to identify system characteristics associated with consistent and timely responses to urgent case reports.”2 A key finding of the investigation was that “public health departments that staff disease reporting hotlines with live operators at all times are more likely to meet federal guidelines designed to help stop the spread of infectious disease.”1 The researchers contacted 124 health departments to participate in testing. Of those 124, 74 health departments were able to participate in the study. Reasons for non-participation were cited as follows: “25 departments did not respond to repeated attempts to contact them, 4 had recently merged with another health department and were no longer responsible for handling urgent case reports, 3 agreed to participate but could not participate in the study time window, and 18 declined to participate.”2 At the onset of investigation, researchers contacted the health directors for consent to random testing and asked that staff remain unaware of the tests. During the random tests, the investigators called health departments during and after business hours, posing as a doctor or nurse at a healthcare facility with an urgent case report of an infectious disease. Based on scripts, callers were instructed to respond to questions by telling the responder that the report was confidential and that it could only be disclosed to a public health professional. To gauge response times, investigators used a standard provided by the U.S. Centers for Disease Control and Prevention (CDC), which at the time required that TBDS at local health departments connect urgent calls with a trained public health professional within 30 minutes (the CDC has since changed required response time to 15 minutes). All health departments in the study received 10 test calls, except if the health department responded to all or none of its first 5 calls in more than 30 minutes, in which case it only received 5 calls due to the low probability that the calls would change the results.2 According to a CIDRAP News report on January 8, the researchers measured the performance of TBDS on their ability to connect a caller reporting an urgent case with a public health professional, the timeframe in which that connection took place, and the consistency with which each health department was able to make such connections. Performance levels were rated as “excellent if all calls were connected to a public health professional were in 30 minutes or less…fair if the response time for one or more calls was more than 30 minutes but less than 240, and poor if the response time was longer than 240 minutes or there was no response.”3 Of the 74 participating health departments, one third of them consistently connected a caller with a public health professional within 30 minutes. Additionally, the study showed that “reaching a live person on the initial call was the strongest predictor of optimal performance…” whereas “the use of automated systems after hours was linked to poor performance.”3 David J. Dausey, lead author of the report and associate policy researcher at RAND, stated that “this study shows that local health departments can indeed achieve consistent and timely responses to urgent case reports…The fact that many departments were unable to respond in a consistent and timely way also demonstrates that there is room for continued improvement.”1 References
|