Addressing the Challenges of Implementing Systematic, Meaningful Disease-Specific Case-Based Control Measures to Monitor Program Effectiveness and Support Performance Measures

BACKGROUND:  The Centers for Disease Control and Prevention (CDC) developed a set of performance measures focused on program accountability and improvement as a requirement of the Public Health Emergency Preparedness (PHEP) cooperative agreement starting in August 2011.  The Public Health Surveillance and Epidemiological Investigation capability included six performance measures, one of which addresses initiation of disease-specific control measures.  Limited guidance was provided on operationalizing data collection for this measure; Florida extensively vetted and revised our approach.

METHODS:  The PHEP disease control measure was defined as the proportion of reports of selected reportable diseases for which initial public health control measure(s) were initiated within the appropriate timeframe.  Examples were provided, but ultimately states were left to determine disease-specific control measures and how they would be monitored.  Input from a statewide Quality Improvement (QI) Workgroup composed of county health department (CHD) and state-level staff was used to identify possible disease-specific control measures and examine feasibility of collecting and monitoring control measure data.  Data collection was piloted and the state’s web-based reportable disease surveillance system was modified to capture control measure data. 

RESULTS:  Initial data collection indicated that CHDs were interpreting the control measures inconsistently, as well as the meaning of the word “initiate”.  In response, control measures were revised to be more detailed and offer more response options that are later classified by system algorithms as being appropriately implemented or not.  A total of 13 control measures were identified and captured (as appropriate) for the six diseases required by the PHEP measure.  Additionally, Florida chose to capture appropriate control measures for salmonellosis and shigellosis.  A full year of data was collected in 2012 from all 67 Florida CHDs and control measures were implemented in the appropriate timeframe for 89% of hepatitis A cases, 100% of meningococcal cases, 72% of Shiga toxin-producing Escherichia coli cases, 45% of salmonellosis cases, and 80% of shigellosis cases.

CONCLUSIONS:  Identifying, operationalizing, and systematically monitoring meaningful control measures was a challenge.  CHDs perceived some control measures as important even though there was little proof of public health impact (e.g., educating people on how they may have been infected).  Florida ultimately decided to include only cases where control measures were actually implemented, as initiation without implementation was not deemed an effective means of disease control.  The developed control measures and collection methods could be adopted by other states.  Better communication between states could result in more systematic nationwide collection and use of meaningful disease control data.