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Baltimore Update: SSuN, 2009. Challenges in implementation. Clinic-based dataset: Existing clinic data system (Insight™) Minimal barriers to electronic data capture and export Greater challenge: Stability of personnel since initiation of grant Population-level GC data Personnel
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Challenges in implementation • Clinic-based dataset: • Existing clinic data system (Insight™) • Minimal barriers to electronic data capture and export • Greater challenge: Stability of personnel since initiation of grant • Population-level GC data • Personnel • Some “soft” resistance on part of supervisory field operations staff
Successes in implementation • Population-level GC data • Staff was recruited and trained (Sept 2009) • Initial completion rates for interview > 70% (first 2 months)
Use of SSuN to Inform Program • Evaluating EPT experience and re-infection rates in clinic (early)
GC population-level data: Procedures • Reported GC cases entered into STD*MIS (routine) • List generated from STD*MIS for 1 week interval (end date 2 weeks prior) • 1/3 selected using randomization.com application, corresponding numbers applied to list from STD*MIS • These 1/3 are chosen for interview
GC population-level data: Procedures, cont • Clinical data (treatment, etc) abstracted from provider morbidity reporting if available, or from STD clinic records • Persons on list contacted by phone (or field visit rarely) by public health investigator under direction of DIS supervisor • Interview to collect expanded behavioral data • Data entry into Access database • Data file re-merged with STD*MIS, then converted into SAS • Cases “closed” if report date > 60 days without interview concluding • Plans to change random selection to 1/6 of reported GC morbidity for December 2009
Patient visits clinic Population-based GC Data Demographic info entered into Insight by clinic staff GC cases reported to BCHD (STD*MIS) Clinic-based Surveillance Data Exam, risk behaviors, labs, diagnosis, treatment entered into Insight by clinician Random selection made from population of Baltimore City gonorrhea cases Data stored on SQL server (Insight) Some information on questionnaire filled out using Insight database Conduct Insight queries: Core, diagnostic, clinical/lab data PID status collected-Insight database (notes section), ER reports or notes section in STD*MIS Export data to Excel (.csv) GC test type information collected-Insight database or lab reports faxed to BCHD Import data into Stata (use StatTransfer) Clean data in Stata: Run contingency tests (use Stata program) Personal interview conducted to collect remaining information Edit data in Stata Questionnaire data entered into Access database (SSuNInterviewdb) Format to SAS file Transfer Access file to Stata using StatTransfer Submit to CDC using SDN certificate or FTP website Conduct data coding tests with Stata program Edit errors in Access database Transfer cleaned Access database to SAS Transfer to CDC using SDN transfer certificate or FTP website