Public health departments that staff disease-reporting hotlines with live operators at all times are more likely to meet federal guidelines designed to help stop the spread of infectious diseases, according to a RAND Corporation study issued today.
Researchers called a national sample of local health departments to report an urgent infectious disease case and found that nearly one-third connected callers to a public health professional within 30 minutes as suggested by the federal Centers for Disease Control and Prevention. The findings appear in the February edition of the American Journal of Public Health.
"This study shows that local health departments can indeed achieve consistent and timely responses to urgent case reports," said David J. Dausey, lead author of the report and an associate policy researcher at RAND, a nonprofit research organization. "The fact that many departments were unable to respond in a consistent and timely way also demonstrates that there is room for continued improvement."
Local health departments are often the first line of defense against a disease outbreak, Dausey said. Because no one can predict where or when a disease outbreak will occur, health departments must be prepared to quickly receive information about potential outbreaks and act as promptly as possible.
Researchers from RAND Health conducted a series of unannounced tests on the telephone-based disease-reporting systems of a representative sample of 74 local health departments nationally. Health directors agreed to participate, but were asked not alert their staff about the exercise.
RAND researchers placed 596 calls to the health departments using trained callers who posed as a doctor or nurse at a local health care facility needing to report an urgent infectious disease case. Callers were instructed to tell all respondents that the case was confidential and the specific case information could only be provided to a trained public health professional designated to respond to such calls.
When the test caller successfully reached a trained public health professional, they were immediately told that the call was a test and that no further action was required.
Between May and October 2006, participating health departments received 5 to 10 test calls -- both during normal business hours and during other times. The average time it took for callers to reach a trained public health professional was 63 minutes, with the longest time being 16 hours, 43 minutes.
Optimal performance in consistently connecting callers with a trained public health professional in 30 minutes or less was achieved by 31 percent of participating health departments. Nearly 40 percent of health departments, however, had one or more cases where researchers never reached a trained public health professional.
Dausey noted that since the study was conducted, the CDC has shortened its guidelines for reaching a trained public health professional from 30 minutes to 15 minutes.
In addition to reaching a live operator, other factors that are likely to be important to meeting federal guidelines include ensuring that telephone operators are trained appropriately and having a system of formal protocols to respond to calls.
"These are complex systems, and there are a number of places where the system can break down," Dausey said. "If you have a single individual responsible for ensuring the call gets evaluated properly, it appears to be more effective than an electronic system where you have to 'press one' to reach this person or 'press two' to leave a message. If someone is out of the office that day, for example, it could lead to problems."
The study, "Measuring the Performance of Telephone-Based Disease Surveillance Systems in Local Health Departments," is now available online at www.ajph.org.
Other authors of the study are Anita Chandra, Agnes Gereben Schaefer, Ben Bahney, Amelia Haviland, Sarah Zakowski and Nicole Lurie, all of RAND. The study was supported by a grant from the U.S. Department of Health and Human Services.
RAND Health, a division of RAND, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care quality, costs and delivery, among other topics.
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