Epi Ready Project

State: KY Type: Neither Year: 2015

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There are 76,854 people in Bullitt County Kentucky, residing in 27,673 households. They work mostly in industry, manufacturing, transportation and distribution. The median income for a household is $53,922. (US Census Bureau, 2010).  The ratio of Primary Care Physicians to residents was 4,965:1 in 2013 (County Health Rankings and Roadmaps, 2013). There are over 60 diseases and conditions reportable to the local health department, per state regulations for healthcare providers. Receiving timely and accurate disease reports is an on-going issue, requiring constant follow-up by BCHD personnel. Disease surveillance in the community is the responsibility of not only the local health department, but also of local providers and laboratories. In order to enhance the disease surveillance in the community, the Bullitt County Health Department developed a multi-tiered plan (titled Epi READY) to educate and engage community healthcare providers.  The primary objective of Project Epi READY was to improve the quality and quantity of communicable disease reports, by:-Meeting personally with each provider to establish and encourage a two way communications pathway for information sharing;-Develop and deliver a resource guidebook of reporting requirements to each provider; and,-Offer a time of instruction to walk through the guidebook and answer any questions providers might have. Members of the BCHD Epi Rapid Response Team (ERRT) developed and produced the Reportable Conditions Resource Guide - a resource guide based on Kentucky laws and regulations, relative to various reportable conditions.  A table of reportable conditions based primarily on requirements set forth by the Council for State and Territorial Epidemiologists (CSTE) case definitions, is the highlight of this tool. Over the course of several months, members of the ERRT visited 34 offices, meeting with 73 providers, and distributing 57 copies of the Reportable Conditions Resource Guide in hardcopy and digital formats. While we are still in the first year of this program, the overwhelming benefit already realized is the increased interaction between providers and the health department.  Reportable disease forms are completed more fully and accurately.  Our infection control nurse supervisor is receiving phone calls from physicians' office staff (whom rarely reported) to report diseases and conditions.  We see the success of this project in the improved communications between community providers and the health department.  The face-to-face meetings with each provider's office has been beneficial so our staff could help navigate the provides and their staff through the Epi Ready Manual.   Understanding that every one learns differently, the manual was provided in both hard copy (binder) and electronic (thumb drives) formats.  We believe this project has had a positive impact on the reportable disease and conditions process.  We expect this project to continue to lead providers toward more accurate and timely reporting. Which in turn, will help us to investigate in a timely manner. The Bullitt County Health Department's Website is www.bullittcountyhealthdept.com.  
There are over 60 diseases and conditions reportable to the local health department, per state regulations for healthcare providers. Receiving timely and accurate disease reports is an on-going issue, requiring constant follow-up by BCHD personnel. In 2013 when a grant opportunity arose, BCHD decided to invest in improving our community’s Epidemiological Surveillance & Reporting through development and distribution of a reportable conditions resource guide. Upon notification of a grant award, the BCHD Epi Rapid Response Team (ERRT) was assembled to fulfill the grant. The Current Approach was examined.1. The requirements for reportable conditions are well established in law. However, physicians don’t always comply due to lack of staff knowledge and a lack of a quick, centralized source of requirements.2. Complicating the problem is the lack of up-to-date physician’s staff contact information available to BCHD. And Potential Solutions were identified.1. Produce a handbook (Resource Guide) containing all pertinent reporting requirements in one handy document.2. Distribute the Resource Guide to every healthcare provider’s office through personal site visits, offering to educate on disease reporting and guidebook usage.3. Obtain current and accurate Point of Contact information for providers, to ensure timely information sharing. An Improvement Theory was developed.BCHD has many resources when investigating reportable diseases and conditions.  We wanted to provide those same resources in a convenient model to providers.  We placed pertinent resources into one manual.  The contents include Kentucky laws pertianing to reportable diseases and conditions;  sections on reporting diseases, blood lead levels, animal bites, and food- and waterborne outbreaks.  We pulled these sections from the Core Clinical Services Guide for local health department nurses, the Kentucky Foodborne and Waterborne Investigation Manual, Kentucky statutes and regulations, along with many other resources.  Case definitions for the reportable disease section are pulled from the Council for State and Territorial Epidemiologists (CSTE) and the CDC's 2012 Case Definitions: Nationally Notifiable Conditions -Infectious and NonInfectious Case. The reference list is included in the manual. Providing the physicians and staff with a quick reference guide to reportable conditions (in hardcopy and digital formats), training more than one staff member per office on therequirements, collecting and updating contact information – will improve the timeliness, quality & quantity of reports; thereby, improving overall community surveillance data. The Improvement Theory was tested.In November 2013, Dr. Praveen Arla, BCHD Medical Director reviewed the Epi READY manual upon completion by the ERRT. Dr. Arla agreed to offer his office as the test site for the manual.
The goal of Project Epi READY is to provide an awareness of reportable conditions to the various medical providers within the community and to improve communication and consistent reporting between providers and the local health department. Ultimately we hope to improve patient care and follow up with a more timely process utilizing a team approach to diagnosing and treating reportable conditions.  Certain diseases and conditions are reportable to the local health department, per state regulations for healthcare providers. Receiving timely and accurate disease reports is an on-going issue, requiring constant follow-up by BCHD personnel. State regulations (KAR 902 02:020) require a provider or laboratory to report diagnoses or laboratory results to the local health department or the state Department for Public Health. This state regulation essentially defines the communicable disease stakeholders as every healthcare provider and laboratory in Bullitt County. When the LHD receives reports of conditions from Kentucky providers or laboratories, further follow up is usually necessary to determine whether or not the case meets the requirements for reporting the illness to the CDC. These requirements are set forth by the Council for State and Territorial Epidemiologists (CSTE) case definition. In order to best serve the community, we requested that each provider contact the Bullitt County Health Department directly. Health department representatives are available, even after hours, in order to provide direction on the given condition being reported. The purpose of the Epi READY resource guide is to provide recommended guidelines regarding appropriate reporting of those required conditions listed within this booklet. These guidelines are based on Kentucky Statutes and current Standards of Care. The goal is to provide an awareness of reportable conditions to the various medical providers within the community and to improve communication and consistent reporting between providers and the local health department. Ultimately we hope to improve patient care and follow up with a more timely process utilizing a team approach to diagnosing and treating reportable conditions. The Epi READY Reportable Conditions Resource Guide provides information relative to various reporting requirements including Tuberculosis, Lead, Animal Bites, and Food and Waterborne Outbreaks.  The most valuable tool within the Resource Guide is the Table of Notifiable Conditions. This table, based primarily on requirements set forth by the Council for State and Territorial Epidemiologists (CSTE) case definitions, is cross-referenced with the Kentucky mandated reporting timeframe for ease of reference. The table is divided into three segments based on the timeline Kentucky has established for reporting the diseases for which surveillance is required.  The first section includes conditions that should be reported within 24 hours and is denoted by a gray background. The second section contains all conditions that should be reported within 1 business day and is denoted by a pink background.  Lastly, the third section includes conditions that should be reported within 5 business days and is denoted by a green background.  Laboratory tests required for case classifications are included in the second column.  The results of the tests included in this column (and only these tests) are what public health needs to fulfill the CDC’s requirement.  Often, if a required lab is not completed a case is not included as a part of Kentucky’s disease surveillance.   If possible, when laboratory tests are ordered to diagnose a patient please order the tests found in this column.The third and final column, entitled “Comments,” includes several pieces of information.  Suggestions for exclusion from public contact, available immunizations, and other information may be listed for some of the conditions.  Most importantly however, comments that describe the documentation that the Health Department requires to make case determinations are included in this column.  In most cases, lab results alone are not sufficient to fulfill the case definition and further follow up is required to determine symptomology and diagnoses.  These comments should act as a guide for what type of information should be gathered and then faxed when reporting a notifiable condition.  If the health department receives all necessary documentation when a report is made, the surveillance system is much more efficient and time that can be devoted to patients is not wasted.    (Below you will find an example a comment included and how to utilize the information)-Comment: “Clinical presentation and laboratory confirmation is required for case determination,” -Interpretation: Lab results and symptoms are needed for case classification  -Action: Complete a KY Reportable Disease Form (EPID 200).  Be sure to include information in all relevant fields and fax to the Bullitt County Health Department along with any lab results. BCHD's Epi Rapid Response Team planned and implemented this project.  This included the public health director, nurse administrator, infectious disease nurese, environmental health manager, emergency preparedness coordinator, and regional epidemiologist.  We worked with our Medical Director to pilot the project in one of his offices before going out to other community providers. This project has certainly fostered a sense of collaboration not only among our Epi Rapid Response Team but with our providers.  We have seen increased interaction between providers and the health department. Reportable disease forms are completed more fully and accurately. Our infection control nurse supervisor is receiving phone calls from physicians' office staff (whom rarely reported) to report diseases and conditions. We see the success of this project in the improved communications between community providers and the health department. The face-to-face meetings with each provider's office has been beneficial so our staff could help navigate the provides and their staff through the Epi Ready Manual. This project was part of a larger project which was grant funded.  Approximately $1,500 went to supplies and printing of the manuals; $4,500 went to staff time and travel for site visits with providers; $2,000 was dedicated to staff time for project development.  The grant was awarded in January 2013. The manuals were completed in June 2013 with site visits scheduled over a 2 month period.  
In March & April 2014, BCHD Epi staff visited 34 offices, speaking with 73 providers and distributing 57 copies of the Resource Guide to Bullitt County healthcare providers, in hard copy manual and portable flash-drive. Participants were given the opportunity to evaluate the product and the presentation.  All evaluations were favorable and feedback was brought back to the planning team. An improvement plan was developed from feedback and includes:-Update as often as necessary to ensure accuracy of information will be an on-goingprocess by Epi staff, as well as -Maintenance of contact information. The 24/7 contact list will be tested annually.-The BCHD Quality Improvement Team will meet annually to evaluate the manual and the process for effectiveness. While it is too early in the process to quantitatively evaluate any change in the quality of reports, the health department is already reaping the benefits of meeting personally with each provider’s office, through the improved personal interaction before, during, and after the occurrence of a reportable condition.
The initial investment to establish this program was substantial.  However, with the required time and production of materials completed, continual maintenance is straight-forward. The primary commitment to sustainability will be in maintaining accurate information.  The health department will continuously evaluate the accuracy of the content, from both a legal and medical standpoint.  As changes occur, it is imperative the health department share the most current information with all guidebook holders to ensure the integrity of the program. The Epi READY Reportable Conditions Resource Guide was developed in such a manner to allow easy updating of one page or one section. Up-to-date contact information for each healthcare provider must be maintained to ensure all stakeholders are receiving any correspondence distributed.  The health department routinely uses the “blast fax” to share appropriate information with providers and the database maintained continuously.  An improvement plan was developed from feedback and includes:-Updates as often as necessary to ensure accuracy of information will be an ongoing process by Epi staff, as well as -maintenance of contact information. The 24/7 contact list will be tested annually.-The BCHD Quality Improvement Team will meet annually to evaluate the manual and the process for effectiveness
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