Improving Timeliness of Communicable Disease Reporting in Arizona: Program Evaluation Perspective

BACKGROUND:   Program evaluation is a well-known practice, using various types of data to understand a program’s performance and improve its outcomes. However, program evaluation is seldom implemented in public health agencies’ communicable disease programs. The purpose of this project was to evaluate outcomes of Arizona’s Electronic Disease Surveillance Program.  One main focus of this program is implementing new methods of communicable disease reporting, including electronic laboratory reporting (ELR), to partially replace traditional methods (mail, fax, and phone calls). One major anticipated outcome of this program is improved timeliness of disease reporting. 

METHODS:   Program evaluation was implemented using CDC’s evaluation framework (MMWR, 1999) and included engaging stakeholders, describing the program, focusing the evaluation design, gathering credible evidence, justifying conclusions, and ensuring use and dissemination of lessons learned. During the program description phase, we determined that one major program outcome is reduction in time to report a disease. Measurable indicators for this outcome are a reduction in mean reporting times and an increased proportion of cases received within required timeframes, by ELR compared to traditional reporting methods.  Confirmed and probable cases reported to public health agencies during 2014 were analyzed. Reporting time was calculated as the number of days between laboratory result and date the report was received by a public health agency.  Only cases with a calculable, positive time frame were included; the highest 0.1% report times were excluded as outliers.  Morbidities with shorter versus longer required reporting times were analyzed separately. 

RESULTS:   24,788 reports were included (88% of total); 32% were first received by ELR.  ELR reporting was significantly faster than traditional methods, for both 24-hour (mean of 0.9 vs. 2.8 days) and 5-day (0.9 vs. 4.1 days) reportable conditions.  A greater proportion of ELR reports were received within the required timeframes (90% vs. 63% for 24-hour and 99% vs. 76% for 5-day). All comparisons were statistically significant.

CONCLUSIONS:   Timely public health reporting of communicable diseases is critical for effective case investigation, implementation of control measures, and maintaining accurate surveillance data. Our data demonstrate a significant improvement in reporting timeliness for reports received via ELR compared to traditional methods. The ongoing transition of hospital and commercial laboratories to ELR should continue to increase the timeliness of reporting; program resources spent on ELR implementation seem well-justified.  Integrating a formal evaluation process into routine program activities should continue to aid epidemiologists in monitoring and demonstrating the effects of our work.