Abstract
Surveillance systems for infectious diseases build the basis for effective public health measures in the prevention and control of infectious diseases. Assessing and improving the quality of such national surveillance systems is a challenge, as many different administrations and professions contribute to a complex system in which sensitive information must be exchanged in a reliable and timely fashion. We conducted a multidisciplinary quality circle on the national public health surveillance system in Germany which included clinicians, laboratory physicians, and staff from local and state health departments as well as from the Robert Koch-Institut. The recommendations resulting from the quality circle included proposals to change the federal law for the control of infectious diseases as well as practical activities such as the change of notification forms and the mailing of faxed information letters to clinicians. A number of recommendations have since been implemented, and some have resulted in measurable improvements. This demonstrates that the applied method of quality circle is a useful tool to improve the quality of national public health surveillance systems.
Highlights
In 2001 the infectious disease control act (IfSG) in Germany resulted in the implementation of a completely restructured and technically modernised national surveillance system for notifiable infectious diseases
Problems identified by clinical and laboratory level: 1.1 Laboratory work for a notifiable disease is not always medically indicated but represents a burden on the clinician’s laboratory budget. 1.2 The notification form is not always readily available and the list of notifiable disease is not known to all clinicians. 1.3 The notification form is complicated. 1.4 Clinicians do not see the benefit of reporting, they are not reimbursed for the time involved in completing and sending the notification. 1.5 Clinicians are reluctant to notify, as they want to prevent their patients from being approached by the public health department
Problems identified by federal public health level: 4.1 Data transfer discontinuity: Information already digitally formatted is transferred to a paperbased text format in order to complete the notification form, sent to the local health departments (LHD) where it must be converted back to a digital format. 4.2 The IfSG is a federal law but the implementation of the law is the responsibility of the states, resulting in numerous problems of standardisation. (For example, some states have additional diseases or slightly different or complementary conditions, notifiable only in their states, causing confusion and lack of comparability.)
Summary
In 2001 the infectious disease control act (IfSG) in Germany resulted in the implementation of a completely restructured and technically modernised national surveillance system for notifiable infectious diseases. B) Case definitions were introduced whereby local health departments must verify notifications before reporting them to the level. C) The federal surveillance institute (Robert Koch-Institut, RKI) became the agency responsible for defining the technical standards by which data is to be reported to the national level, which has resulted in the implementation of a complex electronic database network. Local health departments (LHD) receive paper based case notifications from physicians or laboratories. LHDs forward the case reports electronically using software either produced by the RKI and offered free of charge or one of five commercially available software packages tailored for health department administration [1,2,3]. By 2003 the RKI had conducted a focus group discussion of public health physicians, a survey among general practitioners and a survey among local health
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