BACKGROUND: Overall, syphilis cases in suburban Cook County, comprised primarily of the suburbs around Chicago, increased 49.3% from 2014 to 2015. Early syphilis cases (primary, secondary, and early latent) doubled from 177 in 2014 to 356 in 2015. As part of ongoing quality improvement initiatives at the Cook County Department of Public Health (CCDPH), we evaluated an electronic field tracking database for syphilis field cases in use since 2014. The field tracking database was developed to register cases, assign them to field staff, and to monitor timeliness and disposition of cases.
METHODS: Syphilis cases reported to CCDPH from July 2014 to September 2016 and investigated by field staff were analyzed for timeliness and investigation outcomes. We examined timeliness through two calculated variables: median days from case assignment to acknowledgement by the disease intervention specialists (DIS) and median days from acknowledgement to case closure. We also examined the proportion of cases closed during the study period with a disposition code indicating appropriate treatment of the case.
RESULTS: We identified 1,179 syphilis cases entered into the field tracking database. After eliminating inappropriate duplicates and cases with missing information, 1,151 remained. Of these 917 (79.7%) were assigned. Of these, 65.5% had disposition outcomes indicating treatment; 22.7% were unable to be located. Of the 917 cases 88.2% had diagnosis codes, 45.9% were early syphilis cases. The median time from assignment to acknowledgement of a case in 2014 was 3 days. This number decreased to 1 day in 2015 and rose again to 4 days in 2016. The median time from acknowledgement to closure decreased over time from 50 days in 2014, to 47 days in 2015, to a low of 31 days in 2016.
CONCLUSIONS: Since the implementation of the electronic database system in 2014 there has been an improvement in the overall time taken to close syphilis cases. However, though improvements have been made additional quality improvement initiatives should aim at reducing the amount of discordant information in the field record database and the final case reports and developing a more streamlined system and structure for managing syphilis cases in the field such as the creation of standardized procedures for field staff.