Improving STD Reporting Timeliness: Lessons From Eastern Washington

Summary

Impact Statement:

There was a lag between the time when health care providers diagnosed cases of sexually transmitted diseases and the providers notifying the health department. By improving the timeliness of the reports, the health department could quickly reach and treat contacts of the patient, thus preventing further spread of the disease.

Summary:

Background: Chlamydia, gonorrhea, syphilis, and initial cases of herpes simplex II are reportable by WAC 246-101 within 3 working days of a positive diagnosis. Investigating reported cases can interrupt disease transmission, theoretically reducing incidence and prevalence over time. Delayed reporting impedes timely case investigation, encouraging sustained transmission in a community.

Methods: Using Public Health Issue Management System (PHIMS) records, a 6-month baseline reporting an average of 7 days was calculated from January to June 2010 for all reporting clinics. Twenty-seven clinics reporting greater than 7 days were visited or contacted from August to December 2010 in order to improve their timeliness of sexually transmitted disease (STD) reporting from their baseline of 14 days to at least 10 days by June 30, 2011. During in-office meetings or telephone communication, a local health jurisdiction staff member provided each clinic with its reporting statistics, reviewed the current case report form, and facilitated unstructured brainstorming sessions to identify areas of improvement related to reporting.

Key Findings: Most clinics were unaware of their reporting trends, utilized outdated case report forms, and had difficulties locating patients for notification and/or treatment arrangements. Post-intervention results indicate improvements as the overall reporting average of targeted clinics decreased to 9.5 days: 13 of 27 clinics were reporting within the county average, 10 clinics did not meet the 10-day reporting goal, and 4 clinics had no reportable cases in the measurement period. Additionally, this effort achieved a 64% increase in the number of clinics reporting within the county average (42% [2010] vs. 69% [2011]) Conclusions: Targeted interventions with clinics can improve reporting timeliness. Additional efforts must be conducted with compliant clinics to reinforce positive reporting protocol.

Organization that conducted the QI initiative:

Spokane Regional Health District

Citation:

Hayes, A. Public Health Quality Improvement Exchange. Improving STD Reporting Timeliness: Lessons From Eastern Washington. Mon, 12/17/2012 - 13:57. Available at http://www.phqix.org/content/improving-std-reporting-timeliness-lessons-eastern-washington. Accessed April 23, 2024.

Background and Aim

Planning and Execution Details

QI Implementation:

Twenty-seven clinics in Spokane participated in a targeted quality improvement (QI) project to decrease average STD case reporting time to the local health district responsible for case investigation. Each clinic was contacted by lead STD staff from the health district to arrange an in-person meeting, a staff meeting, or a small team meeting during August to December 2010. During these meetings, STD staff provided each clinic with its STD reporting trends for the period of January to June 2010. STD staff collected information regarding internal protocols for STD case reporting to the health district. Furthermore, STD staff conducted unstructured brainstorming activities with staff to identify root causes of substandard reporting and identify internal areas of improvement related to STD reporting. The main cause of reporting issues was lack of education around STD reporting protocols. STD staff utilized time during the meeting to review pertinent documents and necessary information that must be submitted to the local health district within the required 3 days. Additionally, staff explained the processes of case receipt and investigation at the health district. If additional educational reviews were needed for the clinic, STD staff arranged for in-services based on clinic availability.

Focus activities

Data collection, Epidemiology and Surveillance:

Reportable diseases

Administration:

Data collection and management/Information Technology

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Brainstorming

Pareto Chart

Initiative Dates:

8/1/10 to 8/1/11

Initiative Duration:

Between 6-12 months

Methods of evaluation:

Using a statewide disease database, a 6-month baseline reporting average of 7 days was calculated from January to June 2010 for all reporting clinics. 27 clinics reporting greater than 7 days were visited from August to December 2010 in order to improve their timeliness of STD reporting from their baseline of 14 days to at least 10 days by June 30, 2011. Post-intervention data for the participating 27 clinics were compiled for January to June 2011 and demonstrated that the average number of days to report among these clinics was 9.5 days.

Other Information:

Implementation of this QI Initiative was greatly enhanced through the health district’s relationship with the local STD Medical Coalition. This coalition comprises key medical community leaders, including physicians, medical assistants, and registered nurses who are dedicated to reducing the incidence and prevalence of STDs within the community. STD staff consulted with key members, including the facilitator, to gain insight into the culture of clinical operations to determine strategy and key messages to communicate during in-person meetings.

Supplemental Materials:

Storyboard

Results

Measurable QI Outcomes:

Post-intervention results indicate improvements as the overall reporting average of targeted clinics decreased to 9.5 days: 13 of 27 clinics were reporting within the county average, 10 clinics did not meet the 10-day reporting goal, and 4 clinics had no reportable cases in the measurement period. Additionally, this effort achieved a 64% increase in the number of clinics reporting within the county average (42% [2010] vs. 69% [2011]). Targeted interventions with clinics can improve reporting timeliness.

Other QI Outcomes:

Established a communication pathway between underreporting clinics and the local health district STD program; facilitated timely communication if difficulties were encountered from either entity. Identified clinics requiring additional training and education around implementing patient-delivered partner therapy (PDPT) within the clinic setting. This impacted our activities within the STD program’s logic model framework that focused on changing organizational practices, including increasing the number of clinics within the medical community providing PDPT to clients.

Lessons Learned, Observations and Insights:

Lessons Learned Targeted interventions, with non-compliant entities such as the included initiative, would benefit from including positive reinforcement of behaviors of compliant entities. Positive reinforcement methods for initiatives such as this could include a phone call and/or letter to the clinic manager describing the program’s appreciation of the clinic’s efforts in maintaining/striving for compliance with the law in addition to actively affecting the health of their patients and the community. Observations/Difficulties Providing education and opening dialogue surrounding public health laws is necessary for efficient implementing and identifying opportunities for modifications, if needed. Because of oscillating levels of staff turnover within the medical community, STD staff realized conducting education for one or two persons around STD reporting was not as effective as conducting education for full clinic audiences. Additionally, conducting these in-person meetings allowed health district staff to establish a working relationship that facilitated efficient communication between medical clinics and pertinent STD staff. This communication pathway encouraged more timely reporting from medical clinics when they had a difficult-to-locate infected client and were unable to notify him or her of diagnosis and/or arrange treatment. Describing the health district’s case investigation process to clinical staff also elucidated public health’s vital role in interrupting disease transmission, including its dependent relationship with medical clinics in implementing effective disease control in the community.

Future Plans:

The methodology for this QI intervention has been modified to include Pareto charts as a QI tool. This tool will identify the individual clinics, or clinic groups, that comprise the main percentage of substandard reporting versus conducting interventions with all clinics reporting outside the county average. This QI, in theory, would be maintained by STD staff by communicating quarterly reporting trends to community clinics and conducting targeted interventions with clinics comprising the majority of substandard reporting. Changes in staff, however, have presently minimized this effort and will continue when staffing becomes available.

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Submission Status:

Completed

Comments

Spokane video

If you have not already seen the accompanying video for this QI initiave on the home page, do yourself a favor and take a moment to do so. It is a great compliment piece to the information contained in this submission. Great work, Spokane Regional Health District!

Big thanks to Spokane!

I would like thanks to everyone at Spokane County for their assistance in producing the video highlight for this submission, it looks great and tells an intersting story!

Using the links provided

Using the links provided within the sections of our report has given us the opportunity to learn what others are doing in speciofic areas. The PHQIX ability to associate our work with similar efforts provides us the opportunity to learn from other's successes and challenges. We value this site greatly.

Improving STD Reporting Timeliness: Lessons From Eastern Washington

Summary

Background and Aim

Planning and Execution Details

Results

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

Spokane video

Big thanks to Spokane!

Using the links provided

QI Spotlight

quality improvement together.

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Improving STD Reporting Timeliness: Lessons From Eastern Washington

Summary

Background and Aim

Planning and Execution Details

Results

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

QI Spotlight