Sloane Philip D, MacFarquhar Jennifer K, Sickbert-Bennett Emily, Mitchell C Madeline, Akers Roger, Weber David J, Howard Kevin
Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Ann Fam Med. 2006 Jul-Aug;4(4):351-8. doi: 10.1370/afm.547.
We wanted to evaluate the feasibility of conducting syndromic surveillance in a primary care office using billing data.
A 1-year study was conducted in a primary care practice; comparison data were obtained from emergency department records of visits by county residents. Within the practice, a computer program converted billing data into de-identified daily summaries of International Classification of Diseases, Ninth Revision (ICD-9) codes by sex and age-group; and a staff member generated daily summaries and e-mailed them to the analysis team. For both the practice and the emergency departments, infection-related syndromes and practice-specific thresholds were calculated using the category 1 syndrome codes and an analytical method based upon the Early Aberration Reporting System of the Centers for Disease Control and Prevention.
A mean of 253 ICD-9 codes per day was reported. The most frequently recorded syndromes were respiratory illness, gastrointestinal illness, and fever. Syndromes most commonly exceeding the threshold of 2 standard deviations for the practice were lymphadenitis, rash, and fever. Generating a daily summary took 1 to 2 minutes; the program was written by the software vendor for a fee of dollar 1,500. During the 2003-2004 influenza season, trend line patterns of the emergency department visits reflected a pattern consistent with that of the state, whereas the trend line in primary case practice cases was less consistent, reflecting the variation expected in data from a single clinic. Still, spikes of activity that occurred in the practice before the emergency department suggest the practice may have seen patients with influenza earlier.
This preliminary study showed the feasibility of implementing syndromic surveillance in an office setting at a low cost and with minimal staff effort. Although many implementation issues remain, further development of syndromic surveillance systems should include primary care offices.
我们希望评估在基层医疗诊所利用计费数据开展症候群监测的可行性。
在一家基层医疗诊所进行了为期1年的研究；对照数据取自该县居民急诊就诊记录。在该诊所内，一个计算机程序将计费数据转换为按性别和年龄组划分的国际疾病分类第九版（ICD - 9）编码的去识别化每日汇总数据；一名工作人员生成每日汇总数据并通过电子邮件发送给分析团队。对于该诊所和急诊科，使用第1类症候群编码以及基于疾病控制与预防中心早期异常报告系统的分析方法来计算与感染相关的症候群及诊所特定阈值。
每天报告的ICD - 9编码平均为253个。记录最频繁的症候群是呼吸道疾病、胃肠道疾病和发热。该诊所最常超过2个标准差阈值的症候群是淋巴结炎、皮疹和发热。生成每日汇总数据需要1至2分钟；该程序由软件供应商编写，费用为1500美元。在2003 - 2004年流感季节，急诊科就诊的趋势线模式反映出与该州一致的模式，而基层医疗诊所病例的趋势线则不太一致，反映了单个诊所数据中预期的变化。不过，诊所在急诊科之前出现的活动高峰表明诊所可能更早接诊了流感患者。
这项初步研究表明，在办公室环境中以低成本和最少的工作人员投入实施症候群监测是可行的。尽管仍有许多实施问题，但症候群监测系统的进一步开发应包括基层医疗诊所。
