Distribute Project
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Transcript of Distribute Project
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Update to 2010 State Influenza Coordinator’s ConferenceSession Two – New and Enhanced SurveillanceSunday June 6, 2010 - 3:00-3:15pm, Portland, OR
Distribute Project
Division of Healthcare Information (DHI) (proposed)Public Health Surveillance Program Office (proposed)Office of Surveillance, Epidemiology, & Laboratory Services (OSELS) (Proposed)Centers for Disease Control & Prevention (CDC)
Taha A. Kass-Hout, MD, MSDeputy Director for Information Science (Acting)
Disclaimer: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of The Centers for Disease Control and Prevention.
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Principles & Characteristics• Aggregates counts of ILI and total ED
visits from existing health dept ED-SS systems– Cross-tabulated by a limited number of
variables
• Allows flexibility in use of “chief complaint” (or ICD9) ILI Syndromic criteria that HDs had already developed
• Fosters “community of users”
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A Brief History of Distribute• Proof-of-concept Phase (2006 to July 2009)
– Funding from CDC and Markle Foundation– Recruited nine sites in US and three internationally– Focused on establishing viability of approach
• Pandemic Phase (August 2009 to June 2010)– Expanded funding from CDC lead to CDC, PHII and
ISDS collaboration– Expanded from 10 to 34 sites (including 10
BioSense sites) in ~4months– Enhanced information systems, analyses– Strengthened community support
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Current Status• ED Coverage Estimates
– 34 Health departments (~1,300 EDs) with 8 HDs ≥ 90% ED visit coverage
• Local ILI Syndrome Definitions– Narrow: attempts to replicate ILINet
definition, may exclude many with influenza due to brevity of CC recording
– Broad: less restrictive, yields parallel, higher amplitude signal
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Current Jurisdictions
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Information Pathways
Hospitals HD SS system
Hospitals HD SS system CDC BioSense*
Hospitals HD SS system
Hospitals CDC BioSense*Hospitals
* With HD approval
Via ISDS (UW)
Hospitals HD SS systemHospitals HD SS system Via CDC
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Stratifying Variables
Temperature Disposition Age
6 8
34Number of Jurisdictions
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Disposition (Admission) of ILI Pts
4/1
4/11
4/21 5/
15/
115/
215/
316/
106/
206/
307/
107/
207/
30 8/9
8/19
8/29 9/
89/
189/
2810
/810
/18
10/2
811
/711
/17
11/2
712
/712
/17
12/2
71/
61/
161/
26 2/5
2/15
2/25 3/
73/
173/
27 4/6
4/16
4/26 5/
65/
16
02468
1012141618
% o
f ILI
pat
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s ho
spita
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% o
f ED
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s w
ho w
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hosp
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% o
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I pat
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sno
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Week Ending
Yellow: ILI patients hospitalized ILI patients
Red: ILI patients hospitalized Total ED patients Green: ILI patients non-hospitalized Total ED patients
Source: BioSense
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Public Site
Restricted(Contributor’s) Site
Online Data
http://ISDSDistribute.org
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Comparison to ILINet• State-based
jurisdictions– Correlations ranged from
0.64 to 0.96 with mean and median of 0.83 and 0.83, respectively
• Local-based jurisdictions– Correlations ranged from
0.38 to 0.91 with mean and median of 0.76 and 0.81, respectively
• Visually, major peaks in % ILI in the 2 systems tracked well together
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Community of Practice• Approximately 90 state and local
epidemiologists
• Representing 43 health departments
• Wide range of expertise in syndromic surveillance
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Trade-Offs• Timeliness
– Possible to collect and display daily, HD-specific ILI data (2-3 day lag for most HDs, including censoring for dates with incomplete reporting)
– Instability of daily data: most recent 2-3 day “trends” not consistently born out by subsequent observations
• Flexibility in ILI syndrome criteria– Allowed by using criteria “validated” by state/local
flu surveillance experience– Variability in amplitude of signal precluded
comparisons of H1N1 impact or summary estimate of H1N1 ED visits
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Next Steps• Identification of EDs participating in Distribute and
ILINet to prevent duplication
• Assignment of ED surveillance POC at health departments and collaboration with influenza coordinators
• ILINet and Distribute comparison– CSTE recommended continuing to display Distribute data
separate from ILI-Net (aka, co-visualize)
• Increase coverage (ongoing)
• Address variability in ILI criteria (aka “Harmonize” ILI criteria)
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Acknowledgements• ISDS Staff and Volunteers• Public Health Informatics Institute (PHII)• Project liaisons from NACCHO/CSTE/ASTHO• Support to ISDS
– Tufts Health Care Institute (THCI)– Markle Foundation
• CDC:– NCIRD, Influenza Division– OSELS & former NCPHI – H1N1 response team– OPHPR
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For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.atsdr.cdc.gov
Thank You!