标题：We Can Have It All: Improved Surveillance Outcomes and Decreased Personnel Costs Associated With Electronic Reportable Disease Surveillance, North Carolina, 2010
摘要：Objectives. We assessed the timeliness, accuracy, and cost of a new electronic disease surveillance system at the local health department level. We describe practices associated with lower cost and better surveillance timeliness and accuracy. Methods. Interviews conducted May through August 2010 with local health department (LHD) staff at a simple random sample of 30 of 100 North Carolina counties provided information on surveillance practices and costs; we used surveillance system data to calculate timeliness and accuracy. We identified LHDs with best timeliness and accuracy and used these categories to compare surveillance practices and costs. Results. Local health departments in the top tertiles for surveillance timeliness and accuracy had a lower cost per case reported than LHDs with lower timeliness and accuracy ($71 and $124 per case reported, respectively; P = .03). Best surveillance practices fell into 2 domains: efficient use of the electronic surveillance system and use of surveillance data for local evaluation and program management. Conclusions. Timely and accurate surveillance can be achieved in the setting of restricted funding experienced by many LHDs. Adopting best surveillance practices may improve both efficiency and public health outcomes. Communicable disease reporting is central to public health surveillance, providing data to detect outbreaks and to describe disease trends. 1 Over the past 10 years, communicable disease surveillance has transitioned from traditional paper-based disease reports to electronic reporting. 2 All states have converted parts or all of their disease reporting to electronic systems, and most states now use an electronic system to enter and transmit case information at local and state public health agencies. 3 The transition to electronic reporting has resulted in corresponding modifications to surveillance practice, including changes in who enters and accesses communicable disease case data and how these data are entered at local and state health department levels. 4–6 These and other changes have been described at the state level, 3,7,8 but less information is available describing changes at the local level. Furthermore, there is little documented information on the cost or cost-effectiveness of electronic communicable disease surveillance systems at any level. Because funds for local public health are scarce and must be prioritized on the basis of costs and benefits, information about the costs of electronic disease surveillance is needed. In 2008, North Carolina implemented the North Carolina Electronic Disease Surveillance System (NC EDSS). The goal of this study was to describe the resources dedicated to communicable disease surveillance with NC EDSS at the local health department (LHD) level. We examined the cases reported before and after NC EDSS implementation and calculated personnel costs associated with communicable disease reporting with the NC EDSS system. Finally, we assigned LHDs composite scores on the basis of accuracy and timeliness of case reports, and compared costs and surveillance practices for LHDs with better and worse timeliness and accuracy.
