Providing Mailing Cost Reimbursements: The Effect on Reporting Timeliness of Sexually Transmitted Diseases in Virginia

The first step in the control of any communicable disease is prompt recognition and identification of the disease.1 From a patient-level perspective, this involves efficient diagnoses and treatment of specific conditions. From a population standpoint, prompt recognition and identification involves accurate and timely dissemination of epidemiologic surveillance data to health providers, and communication among local health departments (LHDs), state health departments, and the Centers for Disease Control and Prevention (CDC). The effectiveness of public health surveillance—the ongoing, systematic collection, analysis, and interpretation of outcome-specific data essential to the planning, implementation, and evaluation of public health practice—relies on data timeliness that must be closely integrated and monitored.2 Reporting timeliness of sexually transmitted disease (STD) data is of vital importance to ensure effective evaluation and control activities of highly prevalent infections. STD reporting includes two primary components: (1) timely reporting of data to and from local, state, and federal public health agencies, and (2) timely data entry into STD surveillance applications. Although mutually exclusive activities, these components should be processed uniformly through effective data quality management (DQM) to maintain truly useful surveillance data. The Code of Virginia3 requires that certain communicable diseases, including numerous STDs, be reported to respective LHDs. The LHD then reports this information to the state offices within the Virginia Department of Health, which transmits relevant nationally reportable disease data to CDC.4 CDC provides routine feedback on STD data transmissions as a means of assessing data quality and completeness. However, timeliness of disease reporting is challenging and should be undertaken collectively by state and LHD surveillance staff. Electronic data transmissions, such as improved methods of secured electronic transferability and electronic laboratory records, are currently being reviewed and/or initiated within various Virginia Department of Health program areas. However, STD reporting is, at present, entirely based on paper forms sent through the mail. The sequence of steps that take place to report a condition to the Division of Disease Prevention's (DDP's) STD program are described in Figure 1. Figure 1 Sequence of steps for reporting STDs to the Virginia Department of Health, Division of Disease Prevention As shown in Figure 1, once an LHD receives information about an STD, the LHD fills out a case report form and sends it to DDP via mail. The case report form contains the patient's information (name, address, and basic demographics), the reporting provider's name, the disease diagnosis, and the treatment information. The LHD then initiates a field record to follow up with the patient and possible sex partners; the field record is assigned to the disease intervention specialist (DIS) associated with the LHD. The DIS investigates the case and completes an interview record form, which is then sent to DDP. The date on which the interview record is entered into the STD surveillance database is then considered the report date for DDP. The date the field record is closed is the closest approximation to the report date for the field record. During the late 1990s, DDP worked to institute improvements to its DQM procedures to minimize data-entry backlogs. DDP initiated processes to track receipt of STD mailings from LHDs and to ensure incoming STD data were entered into respective data systems within five days of receipt. Although such procedures improved data timeliness within the state office, they had no impact on LHDs' timeliness in reporting STDs. Thus, DDP attempted to improve the timeliness of STD reporting from LHDs through an incentive program funded by CDC's Outcome Assessment through Systems of Integrated Surveillance cooperative agreement. We investigated the effect of mailing cost reimbursements provided to LHDs on the timeliness of the LHDs' reporting of STDs in Virginia. To our knowledge, this is the first published account of an incentive-based intervention aimed at improving the timeliness of STD data reporting within the U.S.