regional epidemiology unit: update - pihoa: pacific island ... · zika in republic of the marshall...
TRANSCRIPT
Regional Epidemiology Unit:
UpdatePIHOA Meeting
Majuro, Marshall Islands
March 22, 2015
A Mark Durand [email protected]
Haley Cash [email protected]
W Thane Hancock [email protected]
362 Possible Cases 14 Lab-confirmed
(6 pregnant)
Zika in American SamoaJan 1 - Mar 2016
0
5
10
15
20 Suspect cases by diagnosis date
Zika in Republic of the Marshall
Islands, 2015-2016
26 Possible Cases2 Lab Confirmed Cases
(1 Pregnant)
Demographic information on patients who visited a Public Hospital for NCD-related diagnosis, FSM, 2013.
= Confirmed Cases (#)
= Possible Cases (lab
pending)
Zika in the USAPI, Key Points:
1) Zika will come to your place
2) Could be subtle and easy to miss when it comes
3) Serious threat to the unborn child
4) Many unknowns:
Why now?
Long term neurological effects (unborn child, infants,
children/adults)
Sexual and other transmission
Performance of lab tests for Zika
Dynamics of outbreaks in small islands
Outline
• Introduction to Surveillance
• Workforce Development
• DDM, SHIP, OR
• Data Collection in the USAPIs
• Selection of Core Indicators
• Plans for Data Collection and Analysis
• Mechanisms for Reporting/Dissemination
• Links to Action
• Summary of Progress
• Future Goals and Plans
Public Health Surveillance
• The regular and systematic collection, analysis, and
interpretation of health-related data with timely
dissemination for the planning, implementation, and
evaluation of public health practice.
Note: Same process applies to other routine reporting
Derived from: World Health Organization. (April 2015). WHO | Public health
surveillance. Retrieved April 27, 2015.
http://www.who.int/topics/public_health_surveillance/en/. And Centers for Disease
Control. Comprehensive Plan for Epidemiologic Surveillance. Atlanta: US
Department of Health and Human Services, Public Health Service; 1986
Identify health
problem(s)
Collect / Compile
Data
Analyze / Interpret
DataReport /
Disseminate Data
Monitor / Evaluate
System
So it can be
used for
decision-
making!
Regular &
Systematic
Surveillance of Health Information
• Public Health Surveillance Systems
• no single data-collection or research
method can provide the broad range of
information required by countries
• utilize several different data sources
• create a complete picture using multiple
lenses
Key Products for Surveillance
DATA
Reporting
Template
Think about
standardized
frameworks and what
you really need/want
How to collect what
data, how often,
and who is going to
do it
Effectively present data
you’ve collected to
inform and evaluate
ACTION
Surveillance
Plan
Workforce Development
A good surveillance systems are dependent
upon staff who can:
• Operate existing, well-designed data systems
• Assure good quality data inputs
• Use Excel and EpiInfo
• Produce standard, high quality reports
• Understand and can explain reports
DDM & SHIP*
*DDM= Data for Decision Making
(program for making certified Epi-technicians)
*SHIP= Strengthening Health Interventions in the Pacific
(full program to applied epidemiologist fellowship --
masters degree level)
Certificate
(Epi-tech)
Diploma
(Senior
Epi-tech)
Masters
(Field
Epidemiologi
st)
DDM803: Outbreak
Surveillance and
Response
DDM802:
Public
Health
Surveillance
DDM804:
Surveillance
or research
project
DDM801:
Basic
epidemiolog
y and data
analysis
DDM805:
Intermediate
epidemiolog
y and data
analysis
OR 3:
Paper
writing
OR 2:
Data
cleaning
and
analysis
OR 1:
Protocol
Writing
+/-
Optional
thematic
modules
Teaching
DDM
Four
studies/
projects
In-country
residency -
knowledge
transfer,
active
engagement
Certificate
(Epi-tech)
Diploma
(Senior
Epi-tech)
Masters
(Field
Epidemiologi
st)
DDM803: Outbreak
Surveillance and
Response
DDM802:
Public
Health
Surveillance
DDM804:
Surveillance
or research
project
DDM801:
Basic
epidemiolog
y and data
analysis
DDM805:
Intermediate
epidemiolog
y and data
analysis
OR 3:
Paper
writing
OR 2:
Data
cleaning
and
analysis
OR 1:
Protocol
Writing
+/-
Optional
thematic
modules
Teaching
DDM
Four
studies/
projects
In-country
residency -
knowledge
transfer,
active
engagement
Epi Technicians
• Operate existing, well-designed data systems
• Assure good quality data inputs
• Use Excel and EpiInfo
• Produce standard, high quality reports
• Understand and can explain reports
(Cannot design health information systems analyze complex data)
Partners:
Pacific Islands Health Officers Association
Fiji National University
RAPID Project of Hunter New England Health District, Australia
Secretariat of the Pacific Community
University of Guam
World Health Organization
US Centers for Disease Control & Prevention
ASTHO
DDM Independent Project Highlights
• NCD Monitoring and Surveillance Plans
• CD Standard Operating Procedures (SOPs)
• NCD Annual data dashboard template
• CD weekly report template
• Compact indicator SOPs
• Compact indicator annual data dashboard
• Program-specific SOPs for patient tracking
• High-quality annual profiles (e.g. NCD, food safety, Leprosy)
• Hospital and outpatient encounter database reports
NCD Data Collection• Adult Surveillance
• BRFSS, STEPS, Community Health Assessment Surveys
• Cancer registry
• Various SAMHSA NOMs surveys
• Clinical Indicators • Vary by jurisdiction
• Usually reliant on CDEMS software or EMRs
• CDEMS limited to small fraction of NCD care. EHRs not yet adapted to monitor care
• Youth Surveillance• YRBS, GYTS
• Rapid youth survey in Pohnpei and Kosrae in 2015
• Vital Statistics • Ideally, all births and deaths would be certified
• Issues with underlying COD codes, inconsistent reporting
• Missing data (outlying islands)
• Recent SPC workshop to develop state and national vital statistics reports
Core Indicator Scorecard
USAPI
NCD
Core
Surveillance
Indicators
Tobacco Alcohol ↑BMI Diseases
(adult)
Deaths
(30-69 years)
Cig
s-
yo
uth
Cig
s-
adult
Ch
ew
-Y
ou
th
Ch
ew
-adult
Yo
uth
Ad
ult
Yo
uth
Adult
HT
N
DM
↑Cholesterol
All
Cause
Ca
rdio
va
scu
l
ar
Ca
nce
r
Dia
be
tes
Ch
ron
ic
Lung
Am Samoa ↓ N ↓ ↑ N N N N N
CNMI ↓ N ↓ N ↓ N ↑ ↑ ↑ N ↓
Chuuk
Kosrae
Pohnpei
Yap N N N N N ↓ N ↓ N
Guam ↓ ↓ ↑ N ↓ N N N N N N ↑ N ↑ ↑ ↑
Palau ↑ N ↓ N ↓ N N N ↑ ↑ ↑ N N
RMI ↑ ↓ ↑ ↓ N
CNMI NCD Hybrid Survey
• Tobacco, alcohol, NOMs
• Betel nut, e-cigarettes
• Nutrition
• F&V, sugary drinks, processed meats
• Physical activity
• Oral Health
• Cancer Screening
• Health care
• Measurements
• BMI, BP, glucose, cholesterol
Benefits to this survey
• Ongoing adult surveillance
• Using local resources
• Building local capacity
• Data ownership
• Quality data collection- customization
• Breaking down the silos
• Serve as a model for other Pacific jurisdictions
FSM Rapid High School Survey
• Conducted in Pohnpei and Kosrae this fall
• All high school students included
• Run by local State Health Departments
• Indicators included:
• Tobacco smoking and chewing (30 day use)
• Betel Nut (30 day use)
• Alcohol (30 day use)
• BMI (measured)
• School name, classroom, grade, gender, age
Children
(2-8yrs)
Youth
(11-18yrs)
Adults
(18yrs+)
Mortality
(30-69yrs)
Clinical Services
Policy Uptake
CHL Survey
Every 2 years
YRBS
Every 2 years
Adult Hybrid Survey
Every 5 years
Epidemiology Unit- Death
certs w/ NCHS codes
Yearly (rolling 5 yr avg)
EHRs
Yearly
NCD Coalition, yearly
• Overweight/Obesity
• Vegetable intake
• Physical activity
• 30 day tobacco use
• Overweight/obesity
• 30 alcohol use
• Physical activity
• Current tobacco use
• Overweight/obesity
• Binge drinking
• NCD prevalence:
• Hypertension (by BP)
• Diabetes (by blood sugar)
• High cholesterol (by blood cholesterol)
• Premature adult mortality (30-69yrs)
• Cardiovascular disease mortality (30-69yrs)
• Diabetes mortality (30-69yrs)
• Cancer mortality (30-69yrs)
• Chronic lung disease mortality (30-69yrs)
• % hypertensive patients w/ controlled BP
• % diabetic patients w/ controlled blood sugar
• % Early renal failure patients w/ case
management and guildeline directed care
• % RHD patients w/ clinical evaluations
15 Core Policies (PIHOA)
Category Indicators Source/Frequency
*last conducted in 2004
*needs to be analyzed
*needs to be analyzed
Physician- Charts in medical record- Completes diagnosis
section in PEF- Completes Confidential
Morbidity Report on PEF if indicated
ER or Outpatient Department- Paper Medical Record
initiated/retrieved- Patient Encounter Form
(PEF) generated
Public Health Response- Confirm cases- Establish immediate response
needs- Mobilize immediate response
by:- Epidemiologist- CDU staff- Clinical and PH nurses- DEH staff
Belau National Hospital Lab• In house-test completed• Reference lab results
Lab Order
RDDS Lab Report
AND
Reportable Disease SurveillanceDatabase
Epidemiologist
EpiNet Team
CDU Case Investigation
DEH Case Investigation Remediation
WHO, SPC, CDC
For Further Information Rose Zabala (671)735-7304
References:
1- YRBS, BRFSS, GDOE BMI data, Guam Comprehensive
Wellness Program Employee Interest Survey
2- BRFSS
3- Policies from Guam Legislature
Acknowledgements: NCD Consortium Action Teams
Guam NCD Action Team Status
Guam NCD Consortium
Data & Surveillance Action Team
Measurement Baseline
2011
Current
2013
Change Target
(NCD Plan)
Youth Current Smoking 21.9% 20.2% * 18%
Adult Current Smoking 30.5% 26.5% * 25%
Youth Current Drinking 24.7% 23.5% * 22.2%
Youth Binge Drinking 13.6% 12.7% * 12.2%
Adult Current Drinking 41.8% 40.9% * 37.6%
Adult Binge Drinking 18.3% 20.9% 16.5%
Adult Heavy Drinking 6.8% 7.0% * 6.1%
Adult Participating in 150 Minutes or More of
Aerobic Physical Activity Per Week
48.0% 48.7% * 52.8%
High School Students Not Physically Active at
Least 60 Minutes Per Day on 5 or More Days
62.6% 62.7% * 56.3%
High School Students Not Physically Active at
Least 60 Minutes Per Day on All 7 Days
78.2% 76.5% * 70.4%
Youth Obesity 23.6% 23.2% 21.2%
Adult Obesity 27.4% 27.0% 24.7%
Fruit and Vegetable Consumption 16.2% 21.3% -
NCD Risk Factors, Youth and Adults1
Proposed Policies and Initiatives 3
TOBACCO:
Increase tobacco taxes by 100% by December 2018. In
Progress
To remove all Exception in Tobacco Control Mandate. In
Progress
Establish Tobacco Cessation Resources as part of the Worksite
Wellness Program.
In
Progress
Measurement Baseline
2011
Current
2013
Change
Ever diagnosed with diabetes (adults) 9.9% 14.1%
Ever diagnosed with other types of cancer (adults) 1.8% 2.7% *
Ever diagnosed with a stroke (adults) 3.2% 2.6% *
Ever diagnosed with hypercholesterol (adults) 33.1% 38%
Ever diagnosed with hypertension (adults) 20.8% 29.6%
ALCOHOL:
Responsible Alcohol sales and Services Act. Completed
Increase number of policies and laws that encourage healthy
environmental conditions.
In
Progress
Establishing Standardized protocols for clinicians to conduct
alcohol screening and referrals.
In
Progress
Progress
Getting Better
Getting
Worse
PHYSICAL ACTIVITY:
Improve infrastructure that promotes physical activity In
Progres
s
Increase Physical Education Requirements in Schools In
Progres
s
Implement Worksite Wellness Programs In
Progress
NUTRITION:
Promote initiatives that increase availability of and accessibility to
fruits and vegetables.
In
Progress
Establish local public/private partnerships to initiate interventions
to reduce salt intake.
In
Progress
Establish policies that promote breastfeeding. In
Progres
sDiabetes, Cancer, Stroke, Hypercholesterol, Hypertension 2
* Use caution when interpreting
the change as it may not be
statistically significant. Produced by:
Paulino, Y., PhD., Paulino, H., Uncangco, A., Rosadino, G.Note: This is a summary based on the 2015 Data
and Surveillance Highlights (DASH)
15 NCD
Policies
Environment
Youth Risks
- Tobacco
- Alcohol
- Obesity
Adult Risks
- Tobacco
- Alcohol
- Obesity
Diseases:
CVD
Cancer
DiabetesCOPD(HTN)(Lipids)
Deaths
- COPD
-Heart+Stroke
- Cancer
- Diabetes
Link to Action
USAPI NCD Scorecard
Functional NCD M&S
Plan
NCD Policy
Mapping
Done
Good quality
annual NCD
profiles
CNMI Partly done Yes No
FSM National Yes No No
Chuuk No No No
Kosrae Yes No No
Pohnpei Yes Yes Yes
Yap Yes Yes Yes
Guam Partly done Yes Yes
Palau Partly done No Yes
RMI Partly done Partly done No
Am Samoa Yes Yes Yes
Functional CD
Surveillance SOPs
Reliable &
High Quality
Weekly CD
reports
Well
organized
EpiNet
outbreak
response
teams
CNMI No No No
FSM National No No Yes
Chuuk No No No
Kosrae No No No
Pohnpei Yes Yes Yes
Yap No No Yes
Guam Yes Yes Yes
Palau Partly done Yes Yes
RMI Partly done Partly done Partly done
Am Samoa Yes Yes Yes
USAPI CD Scorecard
Summary of Progress
• DDM
• 2 courses completed in Pohnpei
• 1 course completed in Kosrae and Yap
• OR courses 1 and 2 complete
• NCD Adult data collection
• CNMI over 50% complete with NCD Hybrid Survey
• Training and data collection in Palau in May
• NCD Youth data collection
• Rapid High School Survey completed in Pohnpei and Kosrae
Use of Electronic Tools
• Kosrae CHC
• Re-design of work flow, forms, data entry screens and job aids to
facilitate delivery of preventive services and to capture performance
indicators
• Pohnpei DHS-CHC
• Pilot Electronic Health Records project
• New Opportunity Available
• Informatics Project for facilitation of preventive services delivery
and capture of performance indicators- health agencies with
existing EHRs
Recent/Ongoing Extension Services
• Post-typhoon response in CNMI
• Zika response in American Samoa
• Zika response in RMI
• Event-based surveillance in Guam for Pacific Arts Festival
• RMI placement of PIHOA staff
• Performance-based budgeting indicators
• Clinical guidelines for NP Training
• Management consultation
• NIH Grant Application (PIHOA/UH/CMI)
Future Goals / Plans• DDM
• Complete DDM in Pohnpei, Yap, and Kosrae by end of 2016
• Begin in American Samoa in May
• Complete OR course in August 2016
• Hybrid Survey
• Begin data collection in Palau in May
• Begin planning in American Samoa
• FSM Rapid High School Survey
• Complete in Chuuk and Yap
• Develop necessary NCD M&S Plans and Annual Data Dashboards
• Strengthen tools and use of tools
• EHRs for monitoring of clinical indicators
• Continued extension services
• Continued assistance with outbreak response
• Consider developing mechanism for annual NCD mortality reporting
Thank you!
• A Mark Durand [email protected]
• Haley Cash [email protected]
• Thane Hancock [email protected]