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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Marc B. Rosenman, MD1, Stephanie K. Kraft, MD, MPH2, Jaroslaw Harezlak, MS3, Barbara E. Mahon, MD, MPH4, Barry P. Katz, PhD5, Jane Wang, PhD1, and Janet N. Arno, MD6. (1) Regenstrief Institute, Indiana University, 1001 West 10th Street, Indianapolis, IN 46202, 317-630-7447, mrosenma@iupui.edu, (2) Department of Internal Medicine, University of Colorado Health Sciences Center, 4200 E. Ninth Avenue, Denver, CO 80262, (3) Department of Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115, (4) Department of Pediatrics/Section of Adolescent Medicine, Indiana University School of Medicine, 575 Northwest Drive, Indianapolis, IN 46202, (5) Department of Medicine/Section of Biostatistics, Indiana University School of Medicine, 1001 West 10th Street, Indianapolis, IN 46202, (6) Department of Medicine/Section of Infectious Diseases, Indiana University School of Medicine, The Bell Flower Clinic, 1101 West 10th Street, Indianapolis, IN 46202
Objectives: To evaluate how frequently, in a public hospital system, combined gonorrhea/chlamydia tests were accompanied by a serologic test for syphilis (STS), before and after the beginning of interventions designed to curb a syphilis outbreak. Background: In Marion County, Indiana (Indianapolis), a syphilis outbreak began in April 1998. The Marion County Health Department (MCHD) encouraged clinicians to obtain an STS whenever they tested patients for any other STD. Syphilis testing recommendations were posted in emergency rooms, discussed at meetings with clinicians, broadcast to the general public, and mailed to clinicians in selected specialties in 1999 and 2000. In the county public hospital and its affiliated clinics-the hospital system with the largest number of reported syphilis cases-computerized, post-encounter feedback was implemented in the emergency department, urgent visit center, and women's visit center. We focused on how often, in the public hospital system, combined gonorrhea/chlamydia tests were accompanied by an STS. Changes in this clinical practice during the outbreak (and during the multifaceted public health response) could be evaluated using electronic data. Methods: Patient visit and laboratory data were extracted from the Regenstrief Medical Records System, a comprehensive computerized database that includes all laboratory results, encounter data, and demographic information for the county public hospital and its affiliated clinics. We identified all instances between January 1, 1996 and November 22, 2000 of combined gonorrhea/chlamydia tests. For patients with at least one such test, we extracted the dates of all STS. By comparing dates, we determined the proportion of gonorrhea/chlamydia tests that were accompanied within seven days by an STS. We categorized the data into pre-outbreak (1/1/96 to 3/31/98), outbreak pre-intervention (4/1/98 to 2/28/99), and intervention (3/1/99 to 11/22/00) periods. We also determined the patient's age, sex, pregnancy status, zip code, and encounter site, and the clinician's specialty. Results: 90,925 instances of the combined gonorrhea/chlamydia tests were identified; the proportion with an STS increased from 13% (pre-outbreak) to 50% (intervention period) for men and from 6% to 13% for non-pregnant women. Internal medicine was the clinical specialty associated with the highest intervention period STS rate. Among encounter locations, the emergency department/urgent visit center showed the biggest increase from the pre-outbreak to the intervention period (men, 13% to 64%; non-pregnant women, 6% to 15%). Conclusion: During a syphilis outbreak, gonorrhea/chlamydia tests were increasingly accompanied by a syphilis test; this increase coincided with a multifaceted public health response to the outbreak.
Learning Objectives: At the conclusion of this session, the learner will be able to
Keywords: Syphilis Screening, Health Care Delivery
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.