264007 Evaluating the public health referral process among Pennsylvania immigrants with tuberculosis

Sunday, October 28, 2012

Vinay Kumaran, MBBS, MPH , Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA
Curtis E. Cummings, MD, MPH , Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA
Jennifer Torres, MSHS , CBP, CDC Philadelphia Quarantine Station, Philadelphia, PA
Background: The Centers for Disease Control & Prevention (CDC) Division of Global Migration and Quarantine has 20 quarantine stations (QS) across the U.S. Each provides consultation and referral of immigrants with tuberculosis (TB) class B (noninfectious) who enter the U.S. Medical packets of immigrants with infectious diseases are sent from each QS to CDC's Electronic Disease Notification (EDN) system, then forwarded to state and local health departments for referral for clinical follow-up. This study analyzed Philadelphia International Airport (PHL) QS and Pennsylvania Department of Health (PADOH) EDN data, to determine the extent of discrepancies in the referral process.

Methods: Data were obtained from the EDN database maintained by PADOH, for immigrants who had TB class B. EDN data were analyzed to calculate follow-up outcomes, and compare PHL with other QS ports-of- entry. Frequencies, means, modes and medians were calculated.

Results: In 2009 2010, 627 immigrants with TB Class B entered Pennsylvania; 49 arrived via PHL. Of these 49, 8 (16.3%) followed-up at local health departments for further medical evaluation. The mean duration between date of arrival and follow-up was 74 days. For immigrants entering PA from other QS, 153 (24.4%) followed-up.

Conclusions: The EDN system needs improvement. Follow-up rates are low and the time to follow-up is prolonged. Data entry is low priority where resources are low, making follow-up data entry into EDN unstable. Guidance and training for stakeholders to use EDN properly, and better information technology might improve performance.

Learning Areas:
Administer health education strategies, interventions and programs
Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control

Learning Objectives:
1. Discuss issues with the process of referring immigrants with non-infectious tuberculosis, CDC Class B, from CDC Quarantine Stations to local public health in Pennsylvania. 2. Describe the rates of follow-up with local health departments by immigrants with Class B TB, and problems with immigrant TB referral processes in Pennsylvania.

Keywords: TB, Emerging Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health physician, in active practice since 1982, have managed and studied infectious diseases including tuberculosis, and am principal investigator on this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.