BACKGROUND: The Indiana State Department of Health (ISDH) received 3,844 communicable disease reports (CDRs) and 24,138 laboratory reports for hepatitis C virus (HCV) through the Indiana National Electronic Disease Surveillance System (I-NEDSS) between January 1, 2015, and October 31, 2015. Due to the volume of the submissions both ISDH epidemiologists and local health departments (LHD) staff were overwhelmed. We evaluated the length of time to initiate and close an investigation, and recommended areas for improvement.
METHODS: The mean number of days was calculated from ISDH notification to LHD notification; LHD notification to case opened; case opened to case submitted; and case submitted to case closed using system dates, including creation dates of laboratory reports, CDRs and investigations; date laboratory reports were assigned to the LHD; submission date of investigation to ISDH; and date ISDH closed an investigation. Investigations pending completion were included and times were right truncated.
RESULTS: During the study timeframe, 5,368 HCV investigations were initiated and 3,882 investigations were closed. The mean time to notify the LHD through either CDR or laboratory report was 11.84 days (range: 0-173 days; median: 3 days). The mean time for the LHD to open an investigation was 16.89 days (range: 0-305 days; median: 4 days). The mean time for the LHD to complete and submit an investigation to ISDH for review was 32.67 days (range: 0-328 days; median: 15 days). The mean time for an ISDH epidemiologist to close an investigation was 86.35 days (range: 0-332 days; median: 84 days). The mean time from first notification to investigation closure was 163.95 days (range: 0-454 days; median: 155 days). Investigations initiated from a CDR resulted in a mean of 15 fewer days from first notification to investigation closure (mean: 144 days) compared to laboratory reports (mean: 159 days).
CONCLUSIONS: The mean length of time from initial notification to investigation closeout of HCV cases was significant, particularly the time needed for ISDH review. Given the volume of HCV cases reported and limited staffing, ISDH is developing methods to prioritize and streamline HCV investigations for acute HCV infections and special populations, including cases younger than 30 years old and older than 60 years old due to risk factors, including higher likelihood of intravenous drug use and being part of the Baby Boomer generation. In addition, ISDH will utilize public health graduate student interns to assist ISDH with laboratory report assignment to reduce the total time.