法定传染病报告的完整性和及时性：提交给某大型县卫生部门的实验室报告与医疗机构报告的比较
Completeness and timeliness of notifiable disease reporting: a comparison of laboratory and provider reports submitted to a large county health department.
作者信息
Dixon Brian E, Zhang Zuoyi, Lai Patrick T S, Kirbiyik Uzay, Williams Jennifer, Hills Rebecca, Revere Debra, Gibson P Joseph, Grannis Shaun J
机构信息
Indiana University, Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 5000, Indianapolis, IN, 46202, USA.
Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA.
出版信息
BMC Med Inform Decis Mak. 2017 Jun 23;17(1):87. doi: 10.1186/s12911-017-0491-8.
BACKGROUND
Most public health agencies expect reporting of diseases to be initiated by hospital, laboratory or clinic staff even though so-called passive approaches are known to be burdensome for reporters and produce incomplete as well as delayed reports, which can hinder assessment of disease and delay recognition of outbreaks. In this study, we analyze patterns of reporting as well as data completeness and timeliness for traditional, passive reporting of notifiable disease by two distinct sources of information: hospital and clinic staff versus clinical laboratory staff. Reports were submitted via fax machine as well as electronic health information exchange interfaces.
METHODS
Data were extracted from all submitted notifiable disease reports for seven representative diseases. Reporting rates are the proportion of known cases having a corresponding case report from a provider, a faxed laboratory report or an electronic laboratory report. Reporting rates were stratified by disease and compared using McNemar's test. For key data fields on the reports, completeness was calculated as the proportion of non-blank fields. Timeliness was measured as the difference between date of laboratory confirmed diagnosis and the date the report was received by the health department. Differences in completeness and timeliness by data source were evaluated using a generalized linear model with Pearson's goodness of fit statistic.
RESULTS
We assessed 13,269 reports representing 9034 unique cases. Reporting rates varied by disease with overall rates of 19.1% for providers and 84.4% for laboratories (p < 0.001). All but three of 15 data fields in provider reports were more often complete than those fields within laboratory reports (p <0.001). Laboratory reports, whether faxed or electronically sent, were received, on average, 2.2 days after diagnosis versus a week for provider reports (p <0.001).
CONCLUSIONS
Despite growth in the use of electronic methods to enhance notifiable disease reporting, there still exists much room for improvement.
背景
大多数公共卫生机构期望由医院、实验室或诊所工作人员发起疾病报告，尽管所谓的被动报告方式已知对报告者来说负担沉重，且会产生不完整和延迟的报告，这可能会妨碍疾病评估并延误疫情的识别。在本研究中，我们分析了两种不同信息来源（医院和诊所工作人员与临床实验室工作人员）对法定报告疾病进行传统被动报告的报告模式以及数据的完整性和及时性。报告通过传真机以及电子健康信息交换接口提交。
方法
从所有提交的七种代表性疾病的法定疾病报告中提取数据。报告率是指已知病例中有相应病例报告的比例，病例报告来自医疗机构、传真实验室报告或电子实验室报告。报告率按疾病分层，并使用 McNemar 检验进行比较。对于报告中的关键数据字段，完整性计算为非空白字段的比例。及时性以实验室确诊日期与卫生部门收到报告日期之间的差异来衡量。使用具有 Pearson 拟合优度统计量的广义线性模型评估不同数据源在完整性和及时性方面的差异。
结果
我们评估了 13269 份报告，代表 9034 个独特病例。报告率因疾病而异，医疗机构的总体报告率为 19.1%，实验室的报告率为 84.4%（p <0.001）。医疗机构报告的 15 个数据字段中，除了三个字段外，其余字段的完整性均高于实验室报告中的相应字段（p <0.001）。实验室报告，无论是通过传真还是电子方式发送，平均在诊断后 2.2 天收到，而医疗机构报告则为一周（p <0.001）。
结论
尽管使用电子方法加强法定疾病报告的情况有所增加，但仍有很大的改进空间。
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