Enhancing Disease Reporting: Evaluating Healthcare Provider Reporting within Maricopa County

BACKGROUND:  The Maricopa County Department of Public Health, Office of Epidemiology conducts surveillance of communicable diseases, as mandated by Arizona Administrative Codes A.A.C. R9-6-202 and A.A.C. R9-6-204. These codes require healthcare providers (HCPs) to report infectious diseases to local health departments within disease-specific timeframes. The objectives of this study were to identify HCPs who were non-compliant in 2014, by either not reporting or were delayed in reporting, and to provide education, open communication channels, and ultimately decreasing future non-compliant reporting.

METHODS:  Cases reported in the Medical Electronic Disease Surveillance Information System (MEDSIS) in 2014 were analyzed for reporting compliance. A case was defined as any MEDSIS record classified as confirmed or probable for a 24-hour or one-day provider-reportable morbidity. Cases with only a laboratory listed as the reporter were considered non-reported by the HCP. Cases where the HCP reported, but did so outside of the 24-hour or one-day timeframes were considered delayed. Non-compliant HCPs were mailed a letter stating the specific case(s) in non-compliance and a list of the physician-reportable morbidities in Arizona. The data was analyzed using SAS Enterprise Guide version 5.1.  Fisher’s Exact tests were performed, duplicate providers and provider facilities were examined, and the average time of delay was calculated.

RESULTS: Ninety-nine cases, or 12% of all investigated 24-hour and one-day reportable morbidities, were in non-compliance after review. Of these, 61 (62%) were non-reporters, and 38 (38%) were delayed. The average number of days delayed for 24-hour and one-day reportable morbidities was 5.47 and 8 days, respectively. Pertussis was the most frequent morbidity (54; 73%) in non-compliance. Hospitals (32; 43%) and pediatric offices (24; 32%) were the most common facilities in non-compliance. There were significant associations between morbidity group and compliance status (p=0.0436) and between morbidity group and quarter (p=0.0332).

CONCLUSIONS:  The morbidity group most associated to have non-compliant reporting was Vaccine Preventable Illnesses. Seasonality of certain morbidities may contribute to the association between specific quarters where an increase in non-compliance is seen. HCPs not understanding the mandated reporting timeframes as well as that many diseases are to be reported upon suspicion rather than confirmation may lead to non-compliance. Outreach and education will continue to be provided on a quarterly basis in the hopes to decrease non-compliance and maintain communication channels with HCPs. A follow-up study will be conducted to determine whether the intervention has decreased the number of delayed and non-reports.