Bridging The Gap Between

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• Bridging The Gap Between
• Public And Private Health Care
• Influenza-Like Illness Surveillance
• In A Practice-Based Research Network
• Zsolt Nagykaldi PhD, James Mold MD, MPH, Dan
  Hollacher BS,
• Wendy Zhou BS, Mike Crutcher MD, MPH

Oklahoma Physicians Resource/Research Network
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PBRNs Bio-surveillance

• Most PBRNs are affiliated with universities and
  various primary care providers (academic,
  private, community, etc)
• Some PBRNs developed good relationships with the
  public health sector through research grants and
  contracts
• Barriers between the public health system and
  first responders in primary care (admin,
  logistical emotional )
• PBRNs are ideally positioned to connect primary
  care
• providers with public health entities through
  surveillance projects

Oklahoma Physicians Resource/Research Network
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OKPRN A Surveillance PBRN

• OKPRN
• 230 primary care clinicians throughout Oklahoma
• Over 30 research QI projects since 1994
  (grants / contracts)
• Innovative, in-network development and use of
  health IT resources
• Several contracts with the Oklahoma State Dept
  of Health (OSDH)
• OKAlert Influenza-like Illness (ILI) Surveillance
  System
• Dual-use, bidirectional rapid messaging and ILI
  surveillance since 03
• Direct link between primary care docs and state
  health department
• Clinically relevant, weekly feedback to OKPRN
  clinicians on ILI flu
• 30-40 sentinel providers, year-round monitoring,
  real-time data access

Oklahoma Physicians Resource/Research Network
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OKAlert ILI System

• Open-source, secure Java web application
• Available via Palm handhelds as well
• Uses CDC ILI criteria
• - Fever gt 100 F
• - Cough and/or sthroat
• - Myalgia
• Additional e-mail listserv messaging
• Quick stats reports for OSDH and clinicians
• Capability for GIS data mapping - manual

Oklahoma Physicians Resource/Research Network
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ILI Surveillance Results 2003-2006
Oklahoma Physicians Resource/Research Network
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OKAlert Reports Feedback
Oklahoma Physicians Resource/Research Network
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OKAlert - ILI System Parameters

• Timeliness
• Sensitivity Specificity
• Simplicity Acceptability
• Representativeness, Usefulness Importance
• Completeness Validation of Report Data
• Flexibility
• Cost
• Limitations Future Plans

Oklahoma Physicians Resource/Research Network
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Timeliness

• Lag-time between patient visits and reporting
  44 hours
• Rigorous daily routine, multiple ways of
  reporting
• 30-60 seconds to report (web or PDA
  respectively)
• Instant data registering and access to data
• Easy and fast audits, flexible provider feedback
  opts
• Full sentinel provider access to database and
  reports

Oklahoma Physicians Resource/Research Network
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Sensitivity Specificity

• Strong correlation between ILI reports and
  independent lab results for Type A flu (r0.827)
• ILI reports flag peak of flu epidemic 7 days
  earlier than lab results

Oklahoma Physicians Resource/Research Network
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Acceptability Simplicity

• High level of satisfaction (provider surveys and
  continuous personal feedback)
• All versions are easy-to-use and efficient
• No additional training necessary after initial
  tutorial
• 85 of enrolled providers report consistently
  (3-5 days / wk) during flu season
• Only three providers dropped out (2005 season)

Oklahoma Physicians Resource/Research Network
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Representativeness, Usefulness, Importance

• Providers located in 15 counties all regions
  except the Panhandle
• Small, mid-size, large practices private,
  community, academic/residency, Native American
• Valuable addition to existing state surveillance
  networks (hospital / large provider labs)
• Potential in biomedical emergencies (messaging)
• Timely feedback to up to 90 clinicians crucial
  in providing accurate fast clinical response

Oklahoma Physicians Resource/Research Network
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Completeness Validation of ILI Data

• Multi-level server-side client-side data
  validation
• Frequent database audits for inconsistencies
• User confirmation of data entry errors and
  editing
• 0.7 of records excluded due to entry errors
  (05)
• 0.08 of records were deleted by providers (05)

Oklahoma Physicians Resource/Research Network
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Flexibility

• Can handle shift from outbrake detection to
  management via two-way messaging technology
• Multiple means of data entry and feedback
• Scalable IT infrastructure via open-source system
• Tracked parameters can not be quickly modified
  reprogramming takes some time
• A more flexible version is under development to
  track multiple variables year-round

Oklahoma Physicians Resource/Research Network
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Cost

• Initial development funding from federal
  bioterrorism monies through an OSDH contract (50
  K)
• Built on existing office and university/PBRN IT
  infrastructure (computers and Internet access)
• Handheld devices were provided from other PBRN
  research grants and OSDH contracts
• Training, tech support and travel cost are
  supported from OSDH monies

Oklahoma Physicians Resource/Research Network
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Limitations Plans

• 2003-2005 ILI data was not classified by patient
  age group, impact on groups can not be measured
• Difficulty of year-round reporting, only baseline
  surveillance during summer months
• Make the system more flexible and track more
  parameters that can be changed quickly
• Real-time or quasi real-time on-line data mapping

Oklahoma Physicians Resource/Research Network
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Conclusions

• PBRNs have a significant potential for bridging
  the communication gap between the public and
  private health care sector (partnering through
  grants / contracts)
• PBRNs can develop and implement viable and
  effective surveillance systems that are useful
  for both parties
• ILI surveillance is a good place to start ILI
  is easy, quick, and inexpensive to track
• Boosts clinician participation and mobilizes PBRN
• Clinicians receive a service with added clinical
  value
• Clinicians learn about disease surveillance and
  technology

Oklahoma Physicians Resource/Research Network