2006 Model Practice Application (Public)

Sentinel Event Enhanced Passive Surveillance (SEEPS)

San Francisco Department of Public Health

The goal of this program is to improve local preparedness for and response to communicable diseases including infectious disease emergencies with the following objectives: 1) improve clinician ability to diagnose, report, and respond to communicable diseases including those caused by category A agents and emerging infectious diseases by providing relevant and user-friendly resources and 2) strengthen the relationship between San Francisco clinicians and the local health department.

The outcomes of the practice include:

• 3200 San Francisco clinicians received the Infectious Disease Emergencies: A Preparedness and Response Guide for San Francisco Clinicians (a reference binder and CD) with: a) a description of roles and responsibilities for SFDPH and clinicians; b) disease reporting information including the list of legally reportable diseases and conditions; c) family and office preparedness tools; d) detailed disease specific information, e) infection control guidance; and f) common forms and regulations.
  
  
• A user friendly website (www.sfdph.org/cdcp) with communicable disease information and updates, including Health Alerts, Vaccine Updates (Vax Fax), patient fact sheets, and emergency preparedness information was made available to San Francisco clinicians, their patients, and the public. Approximately 10,000 visitors access the website a month.

This project addresses the lack of clinician education and training for their role in communicable disease control and infectious disease emergencies. Bioterrorism and emerging infectious disease presentations were made for 220 clinicians between October and December 2005 and 7 hospitals/clinics requested presentations for the first quarter of 2006.

Communicable disease control is an established and legally mandated core responsibility of public health. Public health practitioners and legislative bodies have long considered communicable disease control relevant to the community. Infectious disease emergencies arise from a subset of the communicable diseases that SFDPH addresses. Infectious disease emergencies require unique interventions and therefore additional preparedness activities. Although infectious disease emergencies are relatively uncommon, they have potential to dramatically and adversely affect our populations as witnessed by the worlds experience with SARS.

As part of the project development, program staff looked at a variety of different model programs. For the Infectious Disease Emergency Guide staff looked at the Santa Cruz Essential Public Health Reporting Guidelines and the LA Terrorism Agent Information and Treatment Guidelines for Clinicians and Hospitals. In addition, staff spoke with the people involved in developing the guidebooks to learn about their development, production, and evaluation experiences. For the content we also looked to journals, medical guides, and information developed by health organizations (CDC, WHO, CIDRAP). The format and content was developed after reviewing these sources and using the best components as a base.

A primary goal of the project was to strengthen the relationship between San Francisco clinicians and the Communicable Disease Control and Prevention Section of the health department. This goal was achieved by sending an ID Guide to every clinician, by creating a website focused on communicable disease control and prevention, and by going out to personally makes presentations on communicable diseases and infectious disease emergencies including emerging infectious diseases and potential bioterrorism related diseases at local hospitals and clinics. By strengthening the relationship between the Communicable Disease Control and Prevention Section and clinicians, the program raises awareness about our disease control activities and the critical and unique role that clinicians play in San Francisco alerting the health department to cases which are the basis for commencing outbreak control activities. In 2006, the program will continue to foster this relationship with additional advisory panel meetings, mailings, and presentations.

The project was implemented between May and December 2005 according to the following schedule:

May 2005

• Research clinician outreach model programs
  
  
• Hold Clinician Advisory Panel
  
  
• Design program
  
  
• Solicit proposals from web developers and graphic designers

June

• Award contract
  
  
• Commence writing of ID Guide content
  
  
• Develop website architecture
  
  
• Begin update of San Francisco clinician address database

July

• Send out ID Guide announcement
  
  
• Develop website content
  
  
• Edit ID Guide content

August

• Finalize ID Guide content and print
  
  
• Finalize website content
  
  
• Finalize update of clinician address database

September

• Website goes live
  
  
• ID Guide distributed to 3000 clinicians by post and delivery

October

• Begin bioterrorism and emerging infectious disease presentations
  
  
• Begin evaluation of program

November

• Ongoing presentations
  
  
• Ongoing evaluation

December

• Ongoing presentations
  
  
• Ongoing evaluation

Passive surveillance plays an essential role in controlling and preventing communicable disease outbreaks. The program believes that clinician reporting will outperform syndromic surveillance in detecting infectious disease emergencies. The leadership in SFDPH supports the commitment to traditional passive surveillance and the continued efforts to enhance and improve clinicians reporting and their ability to appropriately respond to communicable diseases. Clinician groups have welcomed our products. The program expects them to continue their support.

Goal: To improve and maintain high immunization rates in Independence child care facilities using the Child Care Immunization Ordinance.

Objective 1: Clinicians able to diagnose, report, and respond to communicable diseases including emerging infectious diseases and BT diseases by providing relevant and user-friendly resources.

Performance measures: Clinician stakeholder support obtained; Internal stakeholder input & approval process developed; Internal stakeholders approve website architecture, content, ID Guide content; Clinician database up-to-date; Website live; ID Guides distributed to 95% of SF clinicians; and 5 lectures provided.

Outcomes (long-term): From advisory panel: clinicians want information in a variety of formats: hard copy, CD, internet; Topics of interest to public and clinicians changes over time (e.g. flu -> avian influenza); Need to modify presentation emphasis for different groups (e.g., clinicians want less genetics and more diagnosis & treatment).

Objective: To strengthen relationship between clinicians and the local health department.

Performance measures: Advisory panel members support SFDPH; SFDPH provides products in format advisory panel suggests; and Presentations provide useful info.

Outcomes (long-term): Format clinicians prefer, type of information clinicians prefer.