Page 74 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

72 Chapter 3
[43] and systematic monitoring delayed reports (conventional reporting) [51]. In all studies timeliness improved (range several days), however, none of the interventions resulted in sufficient timeliness for predefined or standardized timeframes.
Discussion
To our knowledge, this is the first systematic review assessing timeliness of noti- fication systems. Thirty-nine out of 48 identified studies from 17 different coun- tries provided quantitative data including a predefined timeframe. Timeliness of almost one third of the systems was sufficient, one third insufficient and the others partly sufficient, both for the predefined as the standardized timeframes. Reporting delay by laboratories, either combined with by physicians, was timeli- er than other delays in the notification chain in both timeframes. Outcomes were not related to notification systems. Although electronic systems were faster in comparative studies (10/13), this hardly resulted in sufficient scorings for theirs systems, neither according predefined nor standardized timeframes. The dis- ease specific timeframe for optimal outbreak control was not met by any study.
Notification systems for infectious diseases are country, or even state/prov- ince, specific and therefore difficult to compare [3]. However, the studies in this review demonstrate that many components of the notification chain (Figure 1) are generic, including indicator based reporting on local, regional/national level, reporting by treating physician and/or diagnosing laboratory at local level, and mostly involving legally mandatory notification according to quantitative time- frames (hours, days, weeks). Remarkably, 29 out of the 48 studies involved the delays from physician and/or laboratory to the local health authorities (D3P, D3X or D3X/P). The predefined timeframes, either mandatory or chosen by the au- thors, for this delay where also quite comparable; for example 13 studies used a timeframe of ≤ 1 day. Nevertheless, differences in predefined timeframes do ex- ist; therefore we introduced in this review a standardized timeframe per delay in order to compare notification timeliness between studies. We choose for stan- dardized timeframes delays that were achievable. Eight studies had no timeframe. Although the overall outcome between using the predefined timeframe and the standardized timeframe was comparable, as is shown in Figure 4, the outcomes of over one third of the studies (14/38) changed by applying the standardized timeframe. In our opinion, the outcomes of applying a standardized timeframes are most representative in the appraisal of timeliness of a notification system.