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BACKGROUND: The Influenza Incidence Surveillance Project (IISP) was initiated in 2009 to perform enhanced surveillance for influenza-like illness (ILI) among sentinel health care providers, including laboratory testing for influenza and other respiratory viruses. Personnel from 13 state and local health departments enrolled 4-6 providers and coordinated surveillance activities, including ILI case tracking, specimen collection and testing. Together with the IISP site personnel, we identified best practices for building and maintaining the elements of an enhanced ILI and respiratory virus surveillance system.
METHODS: To identify best practices, IISP primary investigators and surveillance coordinators were solicited to contribute key challenges and lessons-learned. Through monthly conference calls and annual in-person meetings best practice topics within the IISP working group were described and documented.
RESULTS: Key challenges were recruiting providers and maintaining reporting compliance; best practices identified incorporated relationship building, personalized trainings, incentives, and feedback of virologic detections. Providers were recruited most often through the Outpatient Influenza-like Illness Surveillance Network (ILINet) or were exemplary clinics identified through other health department programs. Collaboration with county health departments who have close relationships with local providers was helpful for engaging providers in some sites. Building relationships and maintaining frequent communication with providers was essential for compliance. In-person trainings were effective for building relationships with surveillance staff and identifying problems. Providing each clinic with a binder containing IISP methodology allowed staff to revisit the program methods and facilitated communication between the health department and clinic. In the case of extreme distance or budget constraints, webinars were successful. After trainings, phone calls were preferred for communicating with clinicians, while emails sufficed for administrative staff. Successful providers had an IISP program champion who ensured quality surveillance and acted as liaison between health department and clinic staff. Sharing IISP data with providers was the most important incentive for provider compliance and retention. Sites that budgeted for additional incentives found rapid influenza testing kits, cold and flu care kits, and monetary incentives to be highly valued among clinic staff.
CONCLUSIONS: Consistent communication and data sharing with providers were successful methods to improve compliance and provider retention. Best practices compiled for IISP were largely successful across the program surveillance sites and may be broadly applicable to other surveillance programs in state and local health departments. The greatest challenge for IISP sites was building a sustainable and reliable network of IISP providers.