Primary Care Clinics May Speed Early Alerts to Disease Outbreaks
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Disease outbreaks can be spotted quickly by automated daily data reporting of office-based diagnostic billing codes, according to a pilot study in a family practice clinic.
Investigators found in a North Carolina family practice clinic that that the daily data reporting was faster and more efficient than the emergency room surveillance systems already in place in the state, reported Philip D. Sloane, M.D., of the University of North Carolina at Chapel Hill.
Between July 1, 2003, and June 30, 2004, the FP clinic participating in the study reported 20,649 records, Dr. Sloane and colleagues reported at the American Academy of Family Physicians meeting here. When the team compared these records with those collected by emergency departments in surrounding counties, they found that the primary care clinic data reflected abnormal trends earlier than the emergency rooms.
This held true for the seasonal spikes in influenza symptoms, which Dr. Sloane said worked as an internal control, showing that a primary care surveillance system was functional.
At the end of each day during the study, an assistant at the FP clinic scanned billing records, ran them through a specially designed program to de-identify the data, and sent the results electronically to the research group. Looking at syndromic codes such as botulism-like hemorrhagic illness, localized cutaneous lesion, gastrointestinal, respiratory, or neurologic ills, the team found four signals that stood out over baseline during the study. There were eight such spikes in the emergency room data, with several clustered together.
“The data suggests that primary care practice could be used for early surveillance system,” said Dr. Sloane.
The fact that the data were collected from ICD-9 billing data means the physicians in the primary care office did not have to generate any new data to participate. “If we want to develop surveillance tools, this would be a relatively low-cost option for doing so,” said Dr. Sloane.
Turning that raw data into meaningful surveillance information, however, would be more labor intensive, he acknowledged. Each clinic in a surveillance system would have to have a lead physician who would review the charts to see whether a spike in the coding data really was unusual. “That could still be done within a couple of days,” which is significantly faster than the time required for emergency room reported data.
The CDC already collects data from sentinel primary care facilities scattered across the country to track influenza outbreaks. Since the terrorist attacks in 2001, there has been increased interest at all levels of government in developing tools to rapidly detect a bioterrorist attack. The question is whether emergency rooms or primary care facilities are better able to serve such a function.
The Chapel Hill research teamed hired a medical billing company to write software to convert daily ICD-9 billing codes into de-identified syndromic data, said Dr. Sloane.
Source: AAFP Presentation: Syndromic surveillance for emerging infections in office practice using encounter data: A pilot study.
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