Evaluation of Gonorrhea Surveillance – Connecticut, 2011–2013

BACKGROUND:  Gonorrhea is the second most commonly reported notifiable disease in the United States.  Characterization of reporting processes is essential for accurate surveillance data to guide public health interventions.  This study evaluated the Connecticut gonorrhea surveillance system to determine strengths and weaknesses and provide recommendations to improve future use.

METHODS:  An evaluation of system processes and attributes was conducted using the Centers for Disease Control and Prevention Guidelines for Evaluating Public Health Surveillance Systems.  Quantitative measures of timeliness, data quality, and sensitivity were obtained through analysis of 2011–2012 state surveillance data and through an audit of Connecticut Department of Public Health Laboratory (PHL) data from April–September 2013.  Simplicity, acceptability, and utility were assessed qualitatively through interviews with staff and a survey among the highest reporting healthcare providers by setting type, representing 40% of all reported cases in the state.

RESULTS:  The system has high utility for monitoring incidence and trends.  Seventy percent of surveyed providers said surveillance reports are or would be useful.  While most demographic variables had high completeness, over 30% of race and ethnicity fields were unknown. System simplicity is decreased due to complicated paper-flow, manual data entry, and substantial provider follow-up for missing treatment information (64% of cases).  Twenty percent (4/20) of surveyed providers indicated that reporting cases is a large time burden and 35% (7/20) cited lack of time, staff, and/or electronic reporting as barriers to effective reporting.  Despite this, timeliness of provider reporting from exam date to report date significantly improved from a mean of 17.5 days in 2011 to 12.9 days in 2012 (p<.0001).  Although all gonorrhea test results are usually reported electronically from the PHL within 1–2 days, audit data from the PHL revealed that 35 cases had not been reported on this schedule through the electronic system.  The number of delayed reports ranged between 0–13 per week, varying over the six month audit period.  The sensitivity of reporting from the PHL during this period was 87.7%.

CONCLUSIONS:  Strengths of the system include its usefulness for monitoring trends, data quality, and improved timeliness.  Weaknesses, such as excessive complexity, missing treatment information, and time burden for both health department staff and reporting providers, contribute to lower acceptability.  Timely identification and correction of reporting interruptions is important for maintaining timeliness, stability, and high sensitivity.  Streamlined paper-flow or utilization of electronic reporting systems would greatly benefit the system’s simplicity and data completeness.