Evaluation of Gonorrhea Surveillance – Connecticut, 2011–2013

Background: Gonorrhea is the second most commonly reported notifiable disease in the United States.  Characterization of reporting processes is essential for accurate surveillance data to guide public health interventions.  This study evaluated the Connecticut gonorrhea surveillance system to determine strengths and weaknesses and provide recommendations to improve future use.

Methods: An evaluation of system processes and attributes was conducted using the Centers for Disease Control and Prevention Guidelines for Evaluating Public Health Surveillance Systems.  Quantitative measures of timeliness and data quality were obtained through analysis of 2011–2012 state surveillance data and through an audit of state laboratory data from April–September 2013.  Simplicity, acceptability, and utility were assessed qualitatively through interviews with staff and a survey among the highest reporting healthcare providers by setting type, representing 40% of all reported cases in the state.

Results: The system has high utility for monitoring incidence and trends.  While most demographic variables had high completeness, over 30% of race and ethnicity fields were unknown. System simplicity is decreased due to complicated paper-flow, manual data entry, and substantial provider follow-up for missing treatment information (64% of cases).  Twenty percent (4/20) of surveyed providers indicated that reporting cases is a large time burden and 35% (7/20) cited lack of time, staff, and/or electronic reporting as barriers to effective reporting.  Despite this, timeliness of provider reporting from exam date to report date significantly improved from a mean of 17.5 days in 2011 to 12.9 days in 2012 (p<.0001).

Conclusions: Strengths of the system include its usefulness for monitoring trends, data quality, and improved timeliness.  Identified weaknesses, including excessive complexity, missing treatment information, and time burden for both health department staff and reporting providers, contribute to lower acceptability.  Streamlined paper-flow or utilization of electronic reporting systems would greatly benefit the system’s simplicity and data completeness.