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Population- based Surveillance of Reportable Diseases in Nursing Home Facilities in Nebraska

Population- based Surveillance of Reportable Diseases in Nursing Home Facilities in Nebraska. Manjiri Joshi, MPH + Alison Keyser Metobo , MPH + + Epidemiology Surveillance Response Coordinator. Overview. Background Nursing home increased risk for infection

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Population- based Surveillance of Reportable Diseases in Nursing Home Facilities in Nebraska

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  1. Population- based Surveillance of Reportable Diseases in Nursing Home Facilities in Nebraska Manjiri Joshi, MPH+ Alison Keyser Metobo, MPH+ +Epidemiology Surveillance Response Coordinator

  2. Overview • Background • Nursing home increased risk for infection • Health outcomes in nursing home residents • Baseline for Nebraska cases • Objective • Methods • Estimated incidence rates in nursing home residents • Comparing estimated incidence rates in nursing home residents and non-nursing home cases • Results • Next Steps

  3. Background

  4. Nursing Home residents are at increased risk for infection • Advanced Age • Group Living • Comorbidities • Compromised Immunity • Need for hospitalization

  5. Health outcomes for nursing home residents • Clostridium Difficile infections • Influenza • Methicillin Resistance Staphylococcus Aureus • Vancomycin resistance Enterococci

  6. Compared Nebraska incidence rates with national incidence rates • Establish baseline in Nebraska population

  7. 2010 - revised reportable disease regulations implemented in Nebraska • Conditions added for laboratories reporting via Automated Electronic Laboratory Reporting (ELR)

  8. Objectives • Calculate estimated incidence rates among nursing home residents for selected agents for 2010 ̶ 2011 • Compare estimated incidence rates for nursing home residents and non-nursing home cases who are 65 years and older

  9. METHODS

  10. HL-7 SAS Codes

  11. Nursing home data • “Nursing home associated case”- • any lab report where patient address = Nursing home address • Obtained addresses of all 231 licensed Nursing home facilities • Nursing home line list - 2010 and 2011 • Selected agents • Clostridium Difficile • Enterococcus Sp. • Influenza • Methicillin Resistant Staphylococcus Aureus (MRSA) • Non MRSA Staph • Streptococcus Pneumonia ** For influenza only positive cases were included

  12. Non-nursing home data • Lab report data (ELR) for 2010 ̶ 2011 • Selected agents • Clostridium Difficile • Enterococcus Sp. • Influenza • Methicillin Resistant Staphylococcus Aureus(MRSA) • Non MRSA Staph • Streptococcus Pneumonia ** For influenza only positive cases were included

  13. Estimated incidence rates for nursing home residents 2010 ̶ 2011 Total number of licensed beds in Nebraska were used as proxy for convenience as population at risk to calculate the estimated incidence rates in nursing home facilities Incidence Rate = Number of cases Number of licensed beds* * Proxy for population at risk

  14. Compare estimated incidence rates for nursing home residents and non-nursing home cases • Nursing home cases • Assumption : Majority of the population in nursing home was 65 years and above • All the licensed beds in Nebraska were used by this population Incidence Rate = Number of cases in nursing home who are 65 yrs and older Total number of licensed beds • Non-nursing home cases • Number of cases for 65 years and above was included • Age specific population for Nebraska was used to calculate the incidence (Denominator) Incidence Rate = Number of cases who are 65 yrsand older Population at risk who are 65 yrs and older

  15. RESULTS

  16. Number and proportion of lab reports for which patient address was available

  17. Number and proportion for Nursing homes in Nebraska identified in the Lab reports for 2010 and 2011 • Total Number of Beds – 16,975 • Median: 62 • Range: 4 -329

  18. Nursing home associated cases by age and gender -2010 and 2011

  19. Estimated incidence rates for nursing home residents using total number of licensed beds (16,975) in Nebraska

  20. Estimated incidence rates: nursing home residents vs. non nursing cases (65 years and above)

  21. Evaluation • Chart Review • Validate number of nursing home cases

  22. Next Steps • Add question to the investigation: • “ If you are a nursing home resident?” • Nursing home survey • To get number of residents in each nursing home • Age and gender information

  23. Limitation • Total population in nursing homes • Age specific information for nursing home cases • Address information • No consideration for missing address

  24. Acknowledgement • Bryan Buss*, DVM, MPH, DACVPM • ErynMurphyᴪ MS • Tom Safranek**, MD * CDC Career Epidemiology Field Officer (CEFO), Nebraska Department of Health and Human Services **State Epidemiologist, Nebraska Department of Health and Human Services ᴪEpidemiology Syndromic surveillance Coordinator

  25. THANK YOU !!! Questions?! manjiri.joshi@nebraska.gov

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