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From Data to Signals to Screenshots: Recent Developments in NYCDOHMH ED Syndromic Surveillance.

From Data to Signals to Screenshots: Recent Developments in NYCDOHMH ED Syndromic Surveillance. Marc Paladini New York City Department of Health and Mental Hygiene. Questions. What are we looking for? How are we looking for it? What do we need to find it? What do we do after we find it?

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From Data to Signals to Screenshots: Recent Developments in NYCDOHMH ED Syndromic Surveillance.

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  1. From Data to Signals to Screenshots: Recent Developments in NYCDOHMHED Syndromic Surveillance. Marc Paladini New York City Department of Health and Mental Hygiene

  2. Questions • What are we looking for? • How are we looking for it? • What do we need to find it? • What do we do after we find it? • How does this help us do our job more effectively?

  3. Outline • Introduction to NYC emergency department syndromic surveillance. • Analysis • Signal Investigation • Data Visualization • Future Directions

  4. Analysis

  5. Hospital map

  6. ED Syndromic Surveillance in NYC • Chief complaint – hierarchical syndrome coding • Syndromes: • 1. Sepsis • 2. Respiratory • 3. Rash • 4. Fever • 5. Cold • 6. Diarrhea • 7. Asthma • 8. Vomit • Other

  7. Hospital Statistics - 2005 • 3,136,772 total visits. (7000-10,000 / day)

  8. Data Analysis • Ratio of syndrome/other • Citywide and spatial (zip code, hospital) • Age 13+: respiratory and fever • All ages: diarrhea and vomit • Age group • 0-4 • 5-17 • 18-59 • 60+ • 7 days/week

  9. SIGNALS

  10. Syndromic Analyst • Run surveillance – usually @ 2 hours • Review output for signals • Review signal details • Linelist • Baseline vs. signal frequency tables • Consult with DOH Physician on call (Cluster Doc)

  11. Cluster Doc • Review data with analyst • Ask for further details • Decide on follow up • guidelines/protocol • “fingerprint” of signal

  12. Signals – 2005

  13. Investigation of Signals • Review line list • Check complimentary systems • Acquire interim data (12 hour log) • Call to EDs • Chart reviews • Patient follow up (phone calls) • Augment lab testing/collect specimens • On site epi teams • Special studies (case-control)

  14. Routine Steps • First day (Resp/Fev) vs. 2nd day (Vom/Dia) • Perform descriptive statistics, midday log • Examine CUSUM, other systems • Call hospitals with CUSUM alarms • What did they see yesterday? • What are the seeing today? • Clinical clusters, unexpected severe illness? • Augment lab testing • Alert ED staff

  15. Concerning Features of a Syndromic Signal • Sustained • Multiple hospitals • Large number of excess cases • Uniformity of chief complaints • Young adults or age/sex clustering • Overlapping syndrome signals • Coincident clinician call • Coincident with high profile public event • Concordance with other surveillance systems

  16. Results of Investigations • Some clear seasonal patterns evident • Sharp spikes associated with known events • Rich ecological associations • Difficult to investigate • Used to reinforce public health messages (influenza, viral GI, heat wave, blackout, asthma)

  17. Proposed Prospective Investigation Protocol • All significant resp and fever signals • Chart reviews • Patient interviews • Classify if cases in signal are related • by lab diagnosis, i.e. strep pharyngitis • by clinical diagnosis, i.e. pharyngitis • by risk factor, i.e. subway travel

  18. DATA VISUALIZATION

  19. Intranet

  20. Respiratory intranet

  21. Signal details 1

  22. Signal details 2

  23. Signal details 3

  24. Signal details 4

  25. FUTURE DIRECTIONS

  26. ILI age 1

  27. ILI age 2 - serfling

  28. ILI age 3 - TERS

  29. ILI age 4 - daily

  30. Resp CC

  31. Fev/resp/resp non-feb

  32. Diar/vom age 0-4

  33. Fev resp/fev cold

  34. Questions and Projects • What are we looking for? • Are more fields better? • Discharge diagnosis / ICD-9 code • Disposition • Recorded temperature • Quantify effect of school closings • Day of Week • SaTScan mapping • Age as space

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