Using Evaluation to Plan for the Expansion of a Chronic Disease Surveillance System

BACKGROUND: The Colorado Department of Public Health and Environment (CDPHE) has an integrated chronic disease surveillance system (CDSS) that includes 80 priority indicators spanning 8 program areas (obesity, tobacco, cancer, diabetes, cardiovascular disease, asthma, healthy aging, and mental health).  Data were accessible through an interactive, web-based data dashboard that was only available for internal use; plans to enhance the CDSS dashboard and make it externally-facing were underway.  Concurrently, a department-wide initiative began to improve collaboration for data collection and dissemination with internal and external partners and to understand data priorities of these partners across multiple program areas.  Through these efforts, the CDSS was evaluated in order to guide further enhancement of the system.

METHODS: The Centers for Disease Control and Prevention (CDC) guidance on surveillance system evaluation was utilized.  The CDPHE Data Committee engaged stakeholders during a series of meetings to gather qualitative information related to chronic disease data needs.  Information from these meetings and additional assessments were used to: 1) identify the system’s current strengths, weaknesses, opportunities and threats and 2) assess the overall usefulness, representativeness, timeliness, stability, flexibility, and simplicity of CDSS.     

RESULTS: Four meetings were held to gather input from groups representing state and local public health, disease-specific organizations, coalitions, nonprofit organizations, academia, and other state agencies.  The evaluation yielded important recommendations to improve CDSS.  The integrated nature of CDSS and its stability and flexibility are major strengths, and no major threats were identified.  The weaknesses included limited accessibility within and outside of CDPHE and a technical interface making it difficult to navigate the dashboard and perform queries.  Many data gaps were identified, including: county-level data for certain indicators, data for several minority and under-represented populations, sub-county-level data, and social determinants of health measures.  Furthermore, the CDSS dashboard affords opportunities such as increasing timeliness of data dissemination, and improving alignment and coordination with other efforts and partners (e.g., Colorado’s State Public Health Improvement Plan performance tracking and developing targets for a shared set of indicators within Colorado’s Chronic Disease State Plan).  

CONCLUSIONS: CDPHE’s integrated CDSS provides valuable information to stakeholders to inform and secure funding for program planning.  The system has great potential to perform well on timeliness, flexibility and stability while usefulness, representativeness and simplicity need to be addressed as priorities.  CDPHE’s Data Committee used the evaluation results to develop a department-wide work plan, which includes improving CDSS and other surveillance systems.