Abstract
Objective: Prompt detection of infectious disease outbreaks and rapid introduction of mitigation strategies is a primary concern for public health, emergency and security management organizations. Traditional surveillance methods rely on astute clinical detection and reporting of disease or laboratory confirmation. Although effective, these methods are slow, dependent on physician compliance and delay timely, effective intervention. To address these issues, syndromic surveillance programs have been integrated into the health care system at the earliest points of access; in Ontario, these points are primary care providers, emergency departments (ED), and Telehealth Ontario. This study explores the role of Telehealth Ontario, a telephone helpline, as an early warning system for detection of gastrointestinal (GI) illness.
Methods: Retrospective time-series analysis of the National Ambulatory Care Reporting System (NACRS) ED discharges and Telehealth Ontario data for GI illness from June 1, 2004 to March 31, 2006.
Results: Telehealth Ontario recorded 184,904 calls and the NACRS registered 34,499 ED visits for GI illness. The Spearman rank correlation coefficient was calculated to be 0.90 (p<0.0001). Time-series analysis resulted in significant correlation at lag (weekly) 0 indicating that increases in Telehealth Ontario call volume correlate with increases in NACRS data for GI illness.
Conclusion: Telehealth Ontario call volume fluctuation reflects directly on ED GI visit data on a provincial basis. Telehealth Ontario GI call complaints are a timely, novel and representative data stream that shows promise for integration into a real-time syndromic surveillance system for detection of unexpected events.
Keywords: Syndromic surveillance, bioterrorism, gastrointestinal illness, Telehealth
Résumé
Objectifs: La détection précoce d’épidémies de maladies infectieuses et l’introduction rapide de stratégies d’atténuation représentent une préoccupation de premier plan pour les organismes de santé publique, de secours et de gestion de la sécurité. Les méthodes de surveillance traditionnelles s’appuient sur la détection clinique et le signalement astucieux de maladies ou sur leur confirmation en laboratoire. Même si ces méthodes sont efficaces, elles sont lentes, dépendent du bon vouloir du médecin et retardent l’intervention efficace et opportune. Pour aborder ces questions, les programmes de surveillance syndromique ont été intégrés aux systèmes de soins de santé dans les premiers points d’accès. En Ontario, ces points sont les fournisseurs de soins primaires, le service des urgences et Télésanté Ontario. Dans cette étude, nous explorons le rôle de Télésanté Ontario, une ligne d’aide téléphonique, comme système d’avertissement précoce pour la détection des maladies gastro-intestinales (GI).
Méthodes: Nous avons effectué une analyse rétrospective des séries chronologiques des congés du service des urgences du Système national d’information sur les soins ambulatoires (SNISA) et des données de Télésanté Ontario sur les maladies GI, du 1er juin 2004 au 31 mars 2006.
Résultats: Télésanté Ontario a enregistré 184 904 appels et le SNISA a reçu 34 499 visites aux urgences concernant les maladies GI. Nous avons calculé le coefficient de corrélation de rang à 0,90 (p<0,0001). L’analyse de séries chronologiques a donné lieu à une corrélation importante au point 0 (hebdomadaire), indiquant que les augmentations du volume d’appels à Télésanté Ontario sont en corrélation avec celles des données du SNISA concernant les maladies GI.
Conclusion: Les fluctuations du volume d’appels à Télésanté Ontario reflètent directement les données sur les visites aux urgences à l’échelon provincial concernant les maladies GI. Les appels concernant les maladies GI effectués auprès de Télésanté Ontario représentent un filon de données représentatif, nouveau et opportun qui laisse entrevoir l’avenir d’un bon œil en ce qui concerne leur intégration dans un système de surveillance syndromique en temps réel pour la détection d’événements inattendus.
Mots clés: surveillance syndromique, bioterrorisme, maladies gastro-intestinales, Télésanté Ontario
Footnotes
Acknowledgements: This study was supported by PSI Foundation Grant No. 05- 38 (K. Moore) and CIHR Doctoral Fellowship (E. Rolland). The study was presented as a poster at the Canadian Association of Emergency Physicians annual meeting, June 10, 2008 in Ottawa, ON.
References
- 1.Centers for Disease ControlPrevention. Biological and chemical terrorism: Strategic plan for preparedness and response. Recommendations of the CDC strategic planning workgroup. MMWR. 2000;49(RR04):1–14. [PubMed] [Google Scholar]
- 2.Meinhardt PL. Water and bioterrorism: Preparing for the potential threat to US water supplies and public health. Annu Rev Public Health. 2005;26:213–37. doi: 10.1146/annurev.publhealth.24.100901.140910. [DOI] [PubMed] [Google Scholar]
- 3.O’Toole T. Emerging illness and bioterrorism: Implications for public health. J Urban Health. 2001;78:396–402. doi: 10.1093/jurban/78.2.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Inglesby TV, Grossman R, O’Toole T. A plague on your city; observations from TOPOFF. Clin Infect Dis. 2001;32:436–45. doi: 10.1086/318513. [DOI] [PubMed] [Google Scholar]
- 5.Khan AS, Ashford DA. Ready or not — preparedness for bioterrorism. N Engl J Med. 2001;345:287–89. doi: 10.1056/NEJM200107263450411. [DOI] [PubMed] [Google Scholar]
- 6.Noji EK. Bioterrorism; a ‘new’ global environmental health threat. Global Change & Human Health. 2001;2(1):46–53. doi: 10.1023/A:1011962208444. [DOI] [Google Scholar]
- 7.Ashford DA, Kaiser RM, Bales ME, Shutt K, Patrawalla A, McShan A, et al. Planning against biological terrorism: Lessons learned from outbreak investigations. Emerg Infect Dis. 2003;9(5):515–19. doi: 10.3201/eid0905.020388. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Anonymous. Drinking water security. J Environ Health. 2003;66(2):41. [PubMed] [Google Scholar]
- 9.Luthy RG. Bioterrorism and water security. Environ Sci Technol. 2002;36(7):123. doi: 10.1021/es0222521. [DOI] [PubMed] [Google Scholar]
- 10.Hunter PR, Colford JM, LeChevallier MW, Binder S, Berger PS. Waterborne diseases. Emerg Infect Dis. 2001;7(3):544–45. doi: 10.3201/eid0707.017723. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Christen K. Bioterrorism and waterborne pathogens: How big is the threat? Environ Sci Technol. 2001;35(19):396–97A. doi: 10.1021/es012498q. [DOI] [PubMed] [Google Scholar]
- 12.Torok TJ, Tauxe RV, Wise RP, Livengood JR, Sokolow R, Mauvais S, et al. A large community outbreak of Salmonellosis caused by intentional contamination of restaurant salad bars. JAMA. 1997;278:389–95. doi: 10.1001/jama.1997.03550050051033. [DOI] [PubMed] [Google Scholar]
- 13.Kolavic SA, Kimura A, Simons SL, Slutsker L, Barth S, Haley CE, et al. An outbreak of Shigella dysenteriae type 2 among laboratory workers due to intentional food contamination. JAMA. 1997;278:396–98. doi: 10.1001/jama.1997.03550050058034. [DOI] [PubMed] [Google Scholar]
- 14.Hrudey SE, Huck PM, Payment P, Gillham RW, Hrudey EJ. Walkerton: Lessons learned in comparison with waterborne outbreaks in the developed world. J Environ Eng Sci. 2002;1:387–407. doi: 10.1139/s02-031. [DOI] [Google Scholar]
- 15.Public Health Units, Ministry of Health and Long-Term Care, Province of Ontario. Available online at: http://www.gov.on.ca/health (Accessed November 13, 2007).
- 16.Green MS, Kaufman Z. Surveillance for early detection and monitoring of infectious disease outbreaks associated with bioterrorism. IMAJ. 2002;4:503–6. [PubMed] [Google Scholar]
- 17.Irvin CB, Nouhan PP, Rice K. Syndromic analysis of computerized emergency department patients’ chief complaints: An opportunity for bioterrorism and influenza surveillance. Ann Emerg Med. 2003;41(4):447–52. doi: 10.1067/mem.2003.104. [DOI] [PubMed] [Google Scholar]
- 18.Lober WB, Trigg LJ, Karras BT, Bliss D, Ciliberti J, Duchin JS. Syndromic surveillance using automated collection of computerized discharge diagnosis. J Urb Health. 2003;80(Suppl2):i97–i106. doi: 10.1007/PL00022320. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Pavlin JA, Mostashari F, Kortepeter MG, Hynes NA, Chotani RA, Mikol YB, et al. Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: Results of an interagency workshop on health indicator surveillance. Am J Public Health. 2004;93:1230–35. doi: 10.2105/AJPH.93.8.1230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Cooper DL, Smith G, Baker M, Chinemana F, Verlander N, Gerard F, et al. National syndrome surveillance using calls to a telephone health advice service — United Kingdom, December 2001–February 2003. MMWR. 2004;53(Suppl):179–83. [PubMed] [Google Scholar]
- 21.Baker M, Smith GE, Cooper D, Verlander NQ, Chinemana F, Cotterill S, et al. Early warning and NHS Direct: A role in community surveillance? J Public Health Med. 2003;25(4):362–68. doi: 10.1093/pubmed/fdg096. [DOI] [PubMed] [Google Scholar]
- 22.Cooper DL, Smith GE, Hollyoak VA, Joseph CA, Johnson L, Chaloner R. Use of NHS Direct calls for surveillance of influenza — A second year’s experience. Commun Dis Public Health. 2002;5(2):127–31. [PubMed] [Google Scholar]
- 23.Cooper DL, Smith GE, O’Brien SJ, Hollyoak VA, Baker M. What can analysis of calls to NHS Direct tell us about the epidemiology of gastrointestinal infections to the community? J Infect. 2003;46:101–5. doi: 10.1053/jinf.2002.1090. [DOI] [PubMed] [Google Scholar]
- 24.Rodman J, Frost F, Jabukowski W. Using nursing hotline calls for disease surveillance. Emerg Infect Dis. 1998;4(2):329–32. doi: 10.3201/eid0402.980226. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Espino JU, Hogan WR, Wagner MM. AMIA Annu Symp Proc. 2003. Telephone triage: A timely data source for surveillance of influenza-like diseases; pp. 215–19. [PMC free article] [PubMed] [Google Scholar]
- 26.Rolland E, Moore KM, Robinson VA, McGuinness D. Using Ontario’s Tele-health health telephone helpline as an early-warning system: A study protocol. BMC Health Serv Res. 2006;6:10–17. doi: 10.1186/1472-6963-6-10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Fienberg SE, Shmueli G. Statistical issues and challenges associated with rapid detection of bioterrorist attacks. Statist Med. 2005;24:513–29. doi: 10.1002/sim.2032. [DOI] [PubMed] [Google Scholar]
- 28.Wang L, Ramoni MF, Mandl KD, Sebastiani P. Factors affecting automated syndromic surveillance. AIIM. 2005;34:269–78. doi: 10.1016/j.artmed.2004.11.002. [DOI] [PubMed] [Google Scholar]
- 29.van Dijk A, McGuinness D, Rolland E, Moore K. Can Telehealth respiratory call volume be used as a proxy for emergency department respiratory visit surveillance by public health? Can J Emerg Med. 2008;10(1):18–24. doi: 10.1017/s1481803500009969. [DOI] [PubMed] [Google Scholar]
- 30.Executive summary: Database backgroundgeneral data limitations documentation. National Ambulatory Care Reporting Systems (NACRS) FY 2005–2006. Ottawa, ON: Canadian Institute for Health Information; 2006. [Google Scholar]
- 31.Thakore J, Roach J, Flaherty DH. Clinical administrative databases — Privacy impact assessment. Ottawa, ON: Canadian Institute for Health Information; 2005. [Google Scholar]
- 32.Crighton EJ, Moineddin R, Mamdani MM, Upshur REG. Influenza and pneumonia hospitalizations in Ontario: A time-series analysis. Epidemiol Infect. 2004;132:1167–74. doi: 10.1017/S0950268804002924. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Ontario Ministry of HealthLong-Term Care: Public information — Tele-health Ontario. Ontario Ministry of Health and Long-Term Care. 2007. [Google Scholar]
- 34.Clinidata. Symptom based tele-triage and health information services. 2007. [Google Scholar]
- 35.Doroshenko A, Cooper D, Smith G, Gerard E, Chinemana F, Verlander N, et al. Evaluation of syndromic surveillance based on National Health Service Direct derived data — England and Wales. MMWR. 2005;54(Suppl):117–22. [PubMed] [Google Scholar]
- 36.Bravata DM, McDonald KM, Smith WM, Rydzak C, Szeto H, Buckeridge DL, et al. Systematic review: Surveillance systems for early detection of bioterrorism-related diseases. Ann Intern Med. 2004;140:910–22. doi: 10.7326/0003-4819-140-11-200406010-00013. [DOI] [PubMed] [Google Scholar]
- 37.Lober WB, Karras BT, Wagner MM, Overhage JM, Davidon AJ, Fraser H, et al. Roundtable on bioterrorism detection: Information system-based surveillance. J Am Med Inform Assoc. 2002;9:105–15. doi: 10.1197/jamia.M1052. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Centers for Disease ControlPrevention. Updated guidelines for evaluating public health surveillance systems. MMWR. 2001;50(RR13):1–35. [PubMed] [Google Scholar]
- 39.Moore K. Real-time syndrome surveillance in Ontario, Canada: The potential use of emergency departments and Telehealth. Eur J Emerg Med. 2004;11(1):3–11. doi: 10.1097/00063110-200402000-00002. [DOI] [PubMed] [Google Scholar]