Population health impacts of STI surveillance: a quality improvement project to improve care efficiency and compliance with State reporting requirements

Background- Infectious disease surveillance can inform public health officers on disease morphology, management approaches, disease trends, and disease burden within a demographic. Adequate disease surveillance can also inform funding and resource allocation to mitigate the risk of exposure/community outbreaks. This project was conducted to determine whether the adoption of a disease surveillance workflow and implementing an evidence-based clinical management guideline could enhance clinician attitude and compliance with treatment guidelines. Simultaneously, improving adherence to state reporting requirements to improve patient outcomes in an urgent care clinic ultimately. Method- Full-time and part-time clinical staff (Physicians, Nurse Practitioners. Physician Assistants, Medical Scribe, and Medical Assistants) at an inner-city urgent care clinic were educated on a newly implemented disease surveillance workflow. A data abstraction tool was used to extract the independent and dependent variables in the study. Data collection spanned over 8 weeks before the clinical staff training and implementation of the disease surveillance workflow and 8 weeks after the clinical staff training. The independent variables used in this study were individual patient record on STI, which included the following 11 care component items; sexual risk assessment, reoccurrence, problem list, history, contact tracing, HIV status, medication reconciliation, Preexposure Prophylactic (PrEP), counseling, linkage to care, and STI testing. The dependent variable is the completion rate of the Department of Health (DOH) STI confidential report and its attachment to the electronic chart. Results- Descriptive statistics were used to analyze findings from 78 de-identified charts. Of the 40 charts reviewed before the implementation of the disease surveillance workflow, none of the charts recorded information on PrEP/EPT offering or completion of the New Jersey Department of Health (DOH) STI confidential report. Subsequently, 38 de-identified charts reviewed after implementing the workflow showed improved clinician attitude towards recommending linkage to care, offering PrEP, consistent STI management, and adherence to state reporting requirements. Findings from collected data showed that the post-implementation group's components of care score was higher than the pre-implementation group (Pre-implementation = n=40, Post-implementation = n=38). A Mann-Whitney test indicated that this finding was statistically significant, U = 289.50, z = -4.88, p <.000. State reporting compliance also improved by 100% from baseline. Conclusion- A guided workflow that eliminates system redundancies can improve clinicians’ adherence to management guidelines and public health reporting of infectious disease. Moreover, disease surveillance workflow can inform patient and healthcare system solutions that would efficiently mitigate the risk of spreading infectious diseases and the development of ensuing chronic illnesses.DNPIncludes bibliographical reference