BACKGROUND: Since 1995, the reporting of results from blood lead tests has been required by law in Alaska. The Alaska Department of Health and Social Services (DHSS) collects this information to screen patients, identify sources of lead exposure, and assist with the medical management of patients with elevated blood lead levels. Over the 20 year history of the program, personnel changes, reporting differences, changing data needs, and changes to the demands of the system have added some complications to the system. Recognition of these issues and expected informatics changes within DHSS demand an evaluation of the program to identify areas of improvement and take advantage of an opportunity to modernize and streamline the program.
METHODS: The 2001 CDC Updated Guidelines for Evaluating Public Health Surveillance Systemswere used to assess the proficiencies and limitations of the Alaska Lead Surveillance Program. The system’s simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness, timeliness and stability were all assessed through stakeholder and expert interviews; the main focus of the evaluation was on data quality due to recognition of the need to adapt the surveillance program to new data demands.
RESULTS: For most criteria, the Alaska Lead Surveillance Program was found to be acceptable for program requirements. The program is very effective in identifying at-risk individuals with elevated blood lead levels, especially those working in jobs that expose them to lead. Follow-up with individuals who test with elevated blood lead levels is timely and appropriate. The program is widely accepted by providers and patients, and problems with collection and lab testing are minimal. Although the program data have been sufficient for program needs thus far, several pieces of information are missing from the database or incorrect, such as dates, location, and demographic information.
CONCLUSIONS: Overall, the Alaska Lead Surveillance Program is effective in addressing the needs of the state for lead exposure. Efforts to improve data quality have been proposed and initiated. The findings of this evaluation highlight areas where changes can be made to make data from this system more useful, improve staff capacity, and broaden the program to reach more Alaskans.